KELLY FOSTER - EXP 12/2016 •
OFFICIAL USE ONLY
FORWARD TO P.D.
APPLICATION FOR TAXI OR LIMOSINE FOR HIRE OR RENEWAL W??
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)
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 A.1.) •
Submit photographs with application- Three recent photos must be submitted with application. (lx application, Ix police
dept, lx attach to license when issued)
Driver's Name \A\ jcArA-4Phone number a ) P-1 I "1'1
Driver's Address �(e.0)(.\.11101 City,State and Zipcode ((,a `(517
Mailing Address P-'tOY 110 City State and Zipcode lkeka'►'1 C.t 4l- 47
Valid Washington State Drivers license Number 9to t'Z. , (5.02.030)
Vehicle License lag/Plate Number
Proof of Ownership
ffirthdateS Must be at least 18 years old.
Proof of Insurance
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Business Name and Address ,"-1 ICS City,State and Zipcodel, YAt+Y) 14
• Mailing AddressP1 iX (D� City,State and Zipcode L'tt+✓t✓�'F 6141-9‘ I
Washington State UBI#
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?
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? ND
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,D.
person shall drive a for-hire vehicle,including limousines,within the City without first obtaining a license therefore from the ' .
City. •
I certify my 51 e:nents are true and accurate.My signature authorizes the City of Yelm to verify any information including a driver's I
abstrac.
Signatur. �.�` F.
�it .�r Date 2
r 1 DATE(MMIOO/YYYY)
ACRDCERTIFICATE OF LIABILITY INSURANCE 7/2/2015
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
TOP NOTCH INSURANCE SOLUTIONS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE uOtS NOT AnNEND, EXTEND OR
1100 Virginia St #211 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Seattle, WA 98101
(206)264-6267 INSURERS AFFORDING COVERAGE NAIC#
INSURED FOSTER, KELLY RAY 1 INSURER A: National Indemc;i e.y C%alipony 20087
DBA KELLY KAB r INSURER 8:
PO BOX 1761 INSURER C:.
YELM, WA 98597 INSURER D:' —_
) INSURER E: j
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFOR THE POLICY PERIOD INL .;n I a).NO11 IITHSTANOING
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.
SUR'13bL ! P01.1Y cFF I try
POLICY NUMBER 1nATF. D�irYYY) DA`E�,i,3,11:8M:14; LIMITS
LTR WIRD TYPE OF INSURANCE f !
GENERAL LIABILITY
! EACH OCCURRENCE ' S
I
�I DAMAGE I(TRtRTED
I COMMERCIAL GENERAL LIABILITY! I I PREMISES (EEE occcrsnce) '
CLAIMS MADE 71 OCCUR MED EXP(My c a person) i i
PERSONAL S ADV INJURY . i
T
J GENERAL AGGREGATE 'SS
GEM AGGREGATE LIMIT APPLIES PER . PROOUC rS-CGMPiOP AGG I Y
•
—1 POLICY 7EC n LOC
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AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANYAUTO 1(Ea accidant)
_ALL OWNED AUTOS ! I BODILY 100,000
SCHEDULED AUTOS I(Por peri.n) I' e
A ` HIRED AUTOS 71APR322396 7/3/2015 7/3/2016 BODILYINJUR', 1 1
_ NON-OWNED AUTOS (Par accident) i 300,000 ,
PROPERTY DAMAGE
(Pet acaidert) I I 25,000
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 1 S
R ANYAUTO EA ACC ; i
OTHER THAN ....____,
AUTO ONLY AGG I i
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE i
OCCUR CLAIMSMADE AGGREGATE S
-
DEDUCTIBLE i S
RETENTION S S
WORKERS COMPENSATION WC STATU- ;0TH-i
AND EMPLOYERS'LIABILITY Y/N TO YLIMITS ER
ANY PROPRIETOIVPARTlEfi1000UTIVE r- E.L.EACH ACCIDENT S
OPPICERRM�MER EXCLUDED?
l
I le IRR E.L.DISEASE-EA EMPLOYEE S
MALdssc s under
SPECIAL PRlbOVISIONS below E.L.DISEASE-POLICY LIMIT "s
OTHER
A UIM SPLIT 71APR322396 7/3/2015 17/3/2016 $25/$50/$10
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
EVIDENCE OF INSURANCE
2003 MERC VIN#1MEFM5OU83G626324
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ASOVE DSSCRISED POUC4Et SE CANOE*L ED BEFORE THE EXPIRATION
DEPT OF LICENSING DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR To MAIL 30 DAYS WRITTEN
MASTER LICENSING SERVICE
PO BOX 9034 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL
OLYMPIA, WA 98507 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KBID UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE I/ \\,.. ///\.......:
I
4
ACORD 25(2009/01) 01988-2009 ACeRD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
dWASHINGTON STATE DEPARTMENT Or
LICENSING AEB1445
07/02/2015 Vehicle Registration Certificate
License plate Plate Issue date Tab no Reg expiration Value code Year Mo reg Mo gwt Pwr 'Use Mod yr Make Body.
AEB1445 06/2011 B413611 06/20/2016 21460 2003 12 G CAB 2003 MERC SAB4D
Vehicle ident(VIN)/Serial no Res co Scale wt Seats Model BT Gwt Gwt st Gwt exp ' Fleet Equip
1MEFM50U83G626324 27 3202 SG 4D
Prey plate Filing TBD RTA Tax Service'fae GwtfVeh wt Other Total fees Gwt cr
011 SET $3.00 $5.00 $10.00 $30.75 $48.75
•
FOSTER,KELLY RAY DBA
KELLY KAB
PO BOX 1761
YELM WA 98597
•
Signature of r Istered owne s) Signature of registered owner(s)
Comments:
COLOR-GREEN - DISPLAY TAB ON BACK LICENSE PLATE ONLY FRONT PLATE IS STILL REQUIRED.
Validation code 03341201151830702150022012327 III
•rrrrrl �rtr' :1:414r.
rr
RPT ID: AREGPR-1 This certificate is not proof of ownership.
VehicleRegistration(Fi/8/1.4)E
TD-420-802(R/1/12)Page 1 of 2
Page 1 of 1
1111_, Min _v._ •V.-.1:.t... wA
® WA SHINGTON ACCESS TO CRIMINAL HISTORY
Web Search Transcript
Washington State Patrol
Identification and Criminal History Section
P. 0. Box 42633
Olympia, Washington 98504-2633
Telephone (360) 534-2000 Option 2
THE FOLLOWING TRANSCRIPT OF RECORD
IS FURNISHED FOR OFFICIAL USE ONLY
This report was generated from a transaction run on 2/4/2016 at 8:13 AM
Conviction Criminal History RCW 10.97.050(1)
Pursuant to the purpose of inquiry, NO EXACT MATCH was found in the Washington State
Criminal History Repository based on descriptors provided:
FOSTER,KELLY R DOB 03/28/1969 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.
WATCH did return the following candidate list based on the provided search descriptors:
SID NAME SEX RACE HT WT EYES DOB
1
1.WA17331182 *FOSTER,R SHANER M W 600 210 BRO 5/11/1969
Right Thumb Print (Optional)
1
https://fortress.wa.gov/wsp/watch/Home/PrintResponse?Search=3&PurposeCode=V&Quer... 2/4/2016
WATCH Search Request Results - Washington State Patrol Page 1 of 1
Thursday,February 4,2016
I
� Washi,rgtc�n Access
To criminal
mmia History ����C
WATCH Account • Search Request Results
Candidate list for
SID Name Sex Race Height Weight Eyes Di
No Exact Match Found FOSTER,KELLY R Male Unknown N/A N/A N/A 3,
WA17331182 'FOSTER,R SHANER Male White 600 210 BRO 5,
Found 1 record
https://fortress.wa.gov/wsp/watch/Home/InboxDetail?ResponseType=3&QueryParameter=... 2/4/2016
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