WENDY YONCE - EXP 12/14 4
OFFICIAL USE ONLY
FORWARD TO P.D.
APPLICATION FOR TAXI OR LIMOSINE FOR HIRE OR RENEWAL / 1001
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 T (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-��1 Q- [ /Ay) Phone number.—.400—3c9 —29
Driver's Address !Oio14/; 1�sCity,State and Zipcodeg col/7 l( , 486-9 7
Mailing Address A, tt— City,State and Zipcode �1/
Valid Washington StateDrivers License Number y(3tAnt43f,3 0ple"� (5.02.030)
Vehicle License Tag/Plate Number
Proof of Ownership
Birthdate Q 7-06: 70 Must be at least 18 years old.
Proof of Insurance ` Q
Business Name and Address-e\V�‘�C�� City,State and Zipcode'i
-E\v .ViiiIrCk.Cd5 1
Mailing Address)v(,u \1,ie 1 City,State and Zipcode VA"qS"-1
Washington State t1Bl# lrr(i Z `k33 x„35'
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?,t6
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?,t.IO
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.`73 1 OLCz/I j , /'26i7A., /)F 4-41
I certify my statements are true and accurate.My signature authorizes the City of Yelm to verify any information including a driver's
abstract.
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®
��/zoCERTIFICATE OF LIABILITY
INSURANCE DATE(MM/DD/YYYY)
PRODUCER (206)420-4270 FAX: (206)420-3284 7/7/2014
Key Insurance LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
5200 Southcenter Blvd, Ste 110 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tukwila WA 98188
INSURED INSURERS AFFORDING COVERAGE NAIC#
Kelly Ray Foster, DBA: Kelly Kab INSURER q:Gateway Insurance Company
P.o. Box 1761 INSURER B:
INSURER C:
Yelm INSURER D:
WA 98597
COVERAGES INSURER E:
1
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTAN DING
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 ADD'L
LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE(MMIDD/YYYYI DATE IMM/DD/YYYYI LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
CLAIMS MADE I I OCCUR PREMISES(Ea occurrence) $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY PRO-
JECT LOC _
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE LIMIT
(Ea accident) $
A ALL OWNED AUTOS CAP625481401 –
7/16/2014 7/16/2015
X SCHEDULED AUTOS BODILY INJURY
(Per person) $ 100,000
HIRED AUTOS
NON-OWNED AUTOS BODILY INJURY
(Per accident) $ 300,000
PROPERTY DAMAGE
(Per accident) $ 25,000
GARAGE LIABILITY
ANY
AUTO AUTO ONLY-EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY. AGG $
EXCESS I UMBRELLA LIABILITY
EACH OCCURRENCE
(OCCUR $
CLAIMS MADE _
AGGREGATE $
$
DEDUCTIBLE
_ 8
—
RETENTION $
WORKERS COMPENSATION $
AND EMPLOYERS'LIABILITY WC STATU- DTH-
ANY PROPRIETOR/PARTNER/EXECUTIVE IY/N
I TORY I IMITS I I ER
OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $
(Mandatory in NH)
If yes,describe under E.L.DISEASE-EA EMPLOYEE $
SPECIAL PROVISIONS below
OTHER E.L.DISEASE-POLICY LIMIT $
A CAP625481401 7/16/2014 7/16/2015 uim
25/50/10
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
2003 Mercury Sable 1MEFM50U83G626324
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
faxbls@dor.wa.gov
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30
DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
State of Washington
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Business Licensing Services
P.0 Box 9034 REPRESENTATIVES.
Olympia, WA 98034 AUTHORIZED REPRESENTATIVE
Steve Jones/MJA
ACORD 25(2009/01)
INS025(200901).01 The ACORD name and logo are registered marks of ACORD RD CORPO N. All rights reserved.
WATCH Search Results-No Match - Washington State Patrol Page 1 of 1
Wednesday, October 01,2014
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-
WASHINGTON 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 10/01/2014 at 11:39
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:
YOUNCE,WENDY D DOB 07/05/1970 SEX F 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 10/01/2014
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