WENDY YONCE - EXP 12/2015 OFFICIAL USE ONLY
FORWARD TO P.D.
APPLICATION FOR TAXI OR LIMOSINE FOR HIRE OR RENEWAL
Please complete application to register with the City of Yelm.A renewa/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)
060
Application Fee:$35.00 : ' PAID PROOF RECD-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.(5.02.010 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 /4/Id �, r j�'u"i C& Phone number -4/4/-8.12/22vein? Lig �
Driver's Address /6-a ‹, clh dQ City,State and Zipcode ?6'6 r 7
Mailing Address/6;19d d.lizati.ts5e)y0471'lily State and Zipcode cccc5ri 7
Valid Washington State Drivers License Number XQtt- 2e-AJD3OaIne" (5.02.030)
Vehicle License Tog/Plate Number Re b >,k-ALN`
Proof of Ownershi
Birthdate[7-d --/Q'7G Must be at least 18 years old.
Proof of Insurance
Business Name and Address,C>e.\.\. City,State and Zipcode‘-k-e\W\ W9-
Mailing Address PO MC 1.-1(01 City,State and Zipcode*Am u✓j 'Wt?
Washington State 11BI#lr.c/2-
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 neglige t driving,or of vehicular homicide ar vehicular assault,with five years preceding the date of application for
a license? Aln
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?/10
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. ()yip,
I certify my statements are true and accurate.My signature authorizes the City of Yelm to verify any information including a driver's
abstract.
Signature4,. Dote1110 •
_ ?
•
1
ti
i
AEB1445 ' 0612011 T301684 06/20!2015 21460 2003 12 j G (CAB 2003 ! MERC SAB4D
Vehicle ideal{Vi'AUL Seria!no Res co1 Scale wt Seats Model ET Owl Gwt st Gwl exp Fleet Egaip
1MEFM50U83G626324 27 3202 l^ SG 4D I
Prev plate Piling TED
RTA Tax Subagent OwtNeh at Other Tots:'fees ; Owl t
011SET $3.00 ' $5.00 $10.00 $30.75 ! $48.75 II
FOSTER,KELLY RAY DBA '
KELLY KAS k - -
' - '`" PO BOX 1761 f� _ t 'g'`
YELM WA 9897 k ^eco �` � �.r �^. `�
, � 3-. *° nth ��" - `
g
Signa we of registered ownerlsi Sig-nature of registered owner(s)
Comments:
COLOR-GREEN-DISPLAY TAB ON BACK LICENSE PLATE ONLY-FRONT PLATE IS STILL REQUIRED.
',t --",,IC,:,'. .,`;'0,":.`"".,1,,',4,` ..;,",k‘-,'II'.P,,‘,""..,1,4,,,-1, . - N ''?' '.4 'V! 'I,':k!'• l' 1
'''''',,,,,,,,,''7,,,,'''.,'''''.-1'.;`,A4?A''',-:,..,'-',--'01kk'''';',,0,.-...,.. ,..„44,,,,tflig'i„,'' =---f,"4,,,V,,,i'Am."-,--44,"14'.,' t',:,I'"" /:
''' "'"I'et-I"...,-.,";'",1`,i°2,',;,,,1.,.1.-','"''',,',,",',,,,,,„-APIA4.17‘, '" ---,'-'.,,,,',' '- ' , '' f I
Validation code 01342204141720621140007040761 : ';'� 1 j Ii $r
IRPT ID: AREGPR-1 This certificate is not proof of ownership.
•
A'�� CERTIFICATE OF LIABILITYr
INSURANCE I DATE(MM/OD/YYYY)
PRooUCER (206)420-4270 FAX: (206)420-3284 I 7/7/2014
Key Insurance LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY
5200 Southcenter Blvd, Ste 110
ANHOLDER. TTHIS OCERTIFICATE DOES NOTNFES NO RIGHTS O AMEND, EXTENDN THE ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tukwila WA 98188
leSURIEO
INSURERS AFFORDING COVERAGE NAIC#
INSURER AGateway Insurance Company
Kelly Ray poster, DBA: Kelly Kab
P.o. Box 1761 INSURER B:
INSURER C:
Yells WA 98597 INSURER D:
COVERAGES INSURER E:
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 VNTH 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
POL;CTES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
PtSR ADD/
LTR WSROI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
sena= DATE IMM/DD/YYYYI LIMITS
I GENERAL UABIUTY
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
IIIDAMAGE TO RENTED
• CLAIMS MADE f I OCCUR PREMISES(Ea occurrence) $
MED EXP(Any one person) S
PERSONAL 8 ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY I-1 PJECOT LOC PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE LIMIT
A (Ea accident) $
ALL OWNED AUTOS CAP625981401 7/16/201.4 7/16/2015
BODILY INJURY
SCHEDULED AUTOS
(Per person) $ 100,000
HIRED AUTOS
I
NON-OWNED AUTOS BODILY INJURY
(Per accident) $ 300,000
PROPERTY DAMAGE
(Per accident) $ 25,000
GARAGE LIABILITY '
ANY,AUTO AUTO ONLY-EA ACCIDENT S
OTHER THAN EA ACC '$
•
AGGREGATE
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
7 OCCUR ( i CLAIMS MADE EACH OCCURRENCE $.
$
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION $
AND EMPLOYERS'LIABILITY I WC STA1U-TORY LIMITS IIOTH-
ANv PROPRIETOR/PARTNER/EXECUTIVE Y/N l 1 l ER
•
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) —.
EL EACH ACCIDENT $
If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-EA EMPLOYEE $
OTHER E.L.DISEASE-POLICY LIMIT $
0AP625481901 7/16/2014 7/16/2015 uim
A 25/50/10
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
2003 Mercury Sable 114FM50U83G626329
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
State of Washington DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
BUS1neSS Licensing Services
P.0 Box 9034
REPRESENTATIVES.
Olympia, WA 98034 AUTHORIZED REPRESENTATIVE
Steve Jones/MJA y'I/ 7 /L.L___:___
ACORD 25(2009/01)
INS025(200901).01 The ACORD name and logo are registered marks of ACORD RD CORPO N. All rights reserved.
C-
' WATCH Search Results-No Match - Washington State Patrol Page 1 of 1
Monday, February 02, 2015
®®IMMININ
erre
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 02/02/2015 at 10:04
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 2/2/2015
t R
V
O f III 3
rri,
V E a m
O
00.4kr, kr,
,...,N
1011 RI
M
Ao a `^
1-1
NI erN
coo N
r`` q
W W ri
Z Z «
I
'Ln0 w