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KELLY FOSTER - EXP 12/2014
• • OFFICIAL USE ONLY ' FORWARD 10 P.D. __ APPLICATION FOR TAXI OR LIMOSINE FOR HIRE OR RENEWAL Please complete application to register with the City of Yefm.A reaewa/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 8) Application F,•:$35.00 PAID PROOF REC'D-Waived if applicant has established an approved license from another Thurs • ••my 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 A.1.) 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 Y-.�\ z— Phone number-3)(0Cl" Z Driver's Address C't City,Slate and Zipcode tnLrt.Ct UJB Q 3CC2 Mailing Address X fl ._City State and Zipcode\ tM c. ft � Gl^1 Valid Washington State Drivers License Number�'t' 1 E t✓� 3 L 3 }7Qi (5.02.030) Vehicle license Tag/Plate Number c;k5(40 c—C' Proof of Ownership Birthdate 3 Iza /14(09 Must beat least 18 years old. Proof of Insurance Business Name and Address 14---`e--\ thy,State and Zipcode\ €.\ Mailing AddressX \ 11_ ' _City,State and Zipcode•t46-Vh WA"ctC 5047 Washington State UBI# LC)2—g33 • 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 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 for a license? I`) 3)Are you at least 18 years with no physical or mental infirmity,which jeopardizes the ability to operate a for-hire vehicle.No c , person shall drive a for-hire vehicle,including limousines,within the City without first obtaining a license therefore from the City. I certify my st,Cements are true and accurate.My signature authorizes the City of Yelm to verify any information induding a driver's abstract. ��•• Signature �•Sv Date L2 —3 — 1 WATCH Search Results-No Match- Washington State Patrol Page 1 of 1 Thursday, January 02, 2014 ! WATCII ` ,J 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 09:32 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: FOSTER,KELLY RAY DOB 03/28/1969 SEX U 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&Locallndex=0 01/02/2014 WATCH Profile Management- Washington State Patrol Page 1 of 1 Thursday,January 02, 2014 Account Management Archive Criminal History Request FAQs Forms Help Guide Home View Reports WATCH Inbox Logout RYMYM WATCH Account • Search Request Results Candidate list for SID NAME SEX RACEHTWTEYESDOBNOTARY COPIES 1. No FOSTER,KELLY RAY N/A N/A 0 0 N/A 0 V Request 1 Record Account Management Archive Contact Administrator Criminal History Request FAQs Forms Help Guide Home View Reports WATCH Inbox Logout Copyright©2013 Washington State Patrol https://fortress.wa.gov/wsp/watch/Inbox?Index=0 01/02/2014 ACORD TM CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDIYYYY) 1213112013 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 Company Kelly Ray Foster INSURER B: DBA Kelly Kab INSURER C: P.O.Box 1761 INSURER D: Yelm,WA 98597 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 POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDT. POLICY NUMBER DTE ICYMMIDD/YY) POLICY IMMIDDIYY1 LIMITS TION LTR INSRQ TYPE OF INSURANCE GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ CLAIMS MADE I OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JECOT- P1 LOC A N AUTOMOBILE LIABILITY CAP625481301 07/16/2013 07/16/2014 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) _ ALL OWNED AUTOS BODILY INJURY $ 100,000 X SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ 300,000 - NON-OWNED AUTOS (Per accident) - - PROPERTY DAMAGE $ 25,000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ 1 ANY AUTOOTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S r _ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND I TORY LIMITS ER EMPLOYERS'LIABILITY • E.L.EACH ACCIDENT S ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER A UIM CAP625481301 07/16/2013 07/16/2014 25/50/10 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 2001 MERCURY SABLE 1MEHM55S61G601581 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 NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Olympia,WA 98507 REPRESENTATIVES. AUTHO ESENTATIVE I (KKY) ACORD 25(2001/08) ©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 alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) Printed by KKY on December 31,2013 at 09:04AM WASHINGTON STATE DEPARTMENT OF CP• LICENSING Vehicle Registration Certificate 956YFO g. 04/23/2013 License plate Plate Issue date I Tab no Reg expiration Value code Year Mo reg Mo gwt Pwr Use Mod yr Make , Body 956YFO 01/2009 I 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 X �� X Signature of regist�o''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. 1111, r Validation code 03342203131130423130001038147 r:'T i:t r 1 RPT ID: AREGPR-1 This certificate is not proof of ownership. � � r r VehicleRegistration(R/10/12)E TD-420-802(R/1/12)Page 1 of 2 i r • tri � p �x 4 b 1- or/ ym V Y 1 m Z w\0 11 k 1,;*14 (0 /"'no -.' W rb 11) S S 1111 DO V~ Z:. I'l C4 N V W CO F` 0 y 0(T 01'< c 1--1 W 3 mapp. PP A C 7d