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MATT STEWART - EXP 12/2016 • A O�I DATE(MM/DOlYYYY) CERTIFICATE 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 DOES NOT AMEND, EXTEND OR 1100 Virginia St #211 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Seattle, WA 98101 • (206)264-6267 INSURERS AFFORDING COVERAGE NAICS INSURED FOSTER, KELLY RAYINSURERA National Indemnity Company 120087 DBA KELLY KAB INSURER 8: PO BOX 1761 INSURER C: YELM, WA 98597 INSURER D:: , 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 SUCII POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LrR ffl a• • POLICY NUMBER A .11••12.901111SIES LIMBS GENERAL LIABILITY EACH OCCURRENCE i n.. • 'Iy' COMMERCIAL GENERAL LIABILITY I .CLAIMS MADE 1 OCCUR MED EXP(Any one• son) S ■ ' PERSONAL&ADV INJURY S ■ GENERAL AGGREGATE S GEM.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ ■ POLICY PRO- LOC AUTOMOBILE LIABILRY COMBINED SINGLE LIMIT IIIANYAUTO {Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Fenon) $ 100,000 A ■ HIREDAUTOS 71APR322396 7/3/2015 7/3/2016 BOOILYINJURY $ 300,0001 NINON-OWNED AUTOS ( (Per accident) r III 1111 PROPERTY DAMAGE (Par accident) $ 25,000 GARAGE LIABILITYI III AUTO ONLY-EA ACCIDENT $ 11. ANYAUTO OTHER THAN EAACC S AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S nOCCUR n CLAIMSMADE !AGGREGATE i $ DEDUCTIBLE $ RETENTION $ _ 1$ WORKERS COMPENSATION ■ :. ui AND EMPLOYERS'LIABILITY YIN ANY PROPRITORTARTMERAEDICUTIVE EL.EACH ACCIDENT S OFF:CFIUMEMBER EXCLUDED? (Mandatoy In NHI E.L.DISEASE-EA EMPLOYEE I crndI Unit PRWuISIONS below 1 E.L.DISEASE-POLICY LIMIT $ OTHER A UIM SPLIT 71APR322396 7/3/2015 7/3/2016 $25/$50/$10 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS EVIDENCE OF INSURANCE 2003 MERC VIN#124EFM50U83G626324 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DEECIOIED rouues el CANCELLED BEFORE THE EXPIRATION DEPT OF LICENSING 1 30 DAYS wRlrre"DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL MASTER LICENSING SERVICE PO BOX 9034 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SMALL OLYMPIA, WA 98507 IMPOSE NO OSUGATX1N OR LIABILITY OF ANY KIND UPON THE INSURER,ITI AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �/ ACORD252009/01 � ) ©1988-2009 ACRD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • • •4 WAsKii(TDN STATE DEPNNTNENT Di ` :: • LICENSING • AEB1445 • 07/02/2015 Vehicle Registration Certificate License plate-Plate Issue date Tab no Reg expiration Value code ...YearMo reg Mo gwt Nit.: ..Use Mod yr Make Body AEB1445 06/20'11 ' B413611'. 06/20/2016 21460 2003 12•' : ,O 1 CAg. 2003 MERG _ SAB40_ .• Vehicle`ident'(VIN)/Serial no • Res co Scale wt 'Seats.•-Model A:[.,__..Gwt•-•-i••• .Gi4tt St..f,' • . Gwt,exp• :' Fleet Equip 1MEFM50U83G626324 27 3202, ;- • • ....' ..-.--:0.0.; ,..40... .......;, ;: ._" Prey plate Filing . ':TBD • • ; :R1TATaX SeMcefoit: `;'.1Gw1%lreb,wt.•.. Other Total fees' Gwtcr ' 011SET • $3.00.. ' .‹•:,'C'"':',': $30:75 ' • •�' .. -•�5:�0-_'•: �'r 31.0:{>DI :$48:75 • • • FOSTER,KELLY • . f ,. ,._! ! • 1 RAY ,r , KELLY KAB - :,l js- • ": , POBOX`1761 -;:--•.;-1.-;r•-• •.xw ! • YEL•M WA'98591\ i r -i.,. .,.,'":.' 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V C__f m z 3 z m m x ...0 D D Zm W m L m0= m cn w Q Z to n1 m o m Do I-- -0 ® m m V CT Z IVN N ® m m V N • Page 1 of 1 i WAT C H WASHINGTON ACCESS TO CRIMINAL HISTORY Web Search No Record Found Report 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 1/28/2016 at 12:34 PM 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 descriptors provided: STEWART,MATTHEW J 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. 1 1 https://fortress.wa.gov/wsp/watch/Home/PrintResponse?Search=2&PurposeCode=V&Que... 1/28/2016 • tilli • a ililit 111 Q 3 w Lil GIp;4.4 124 n> E co Ln /� k �wY01 01v W N et c4 cv ,-1 c• ! W rx T.# S°i. to Q i. o� ti [Tl UNQ Q W `C. • 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 renewo/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.l.) 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 M� / -et-.) 57,4-et-,/ANr- Phone number .;6?)--; ,S`� ��`�:2 Driver's Address C70I c &P/eriI_5 tikity,State and Zipcode -�(�"'► �- � 6-5! � Mailing Address ?c2 A /2 �yC ty.State and Zipcode e l �� q5c 7 , Valid Washington State Drivers License Number De 1-✓%rkv' 1 7G ('e (5.02.030) • Vehicle License Tag/Plate Number Ai- r3 1 5 Proof of Ownership Birthdate Co- 1 7 - I''G I Must be at least 18 years old. Proof of Insurance Business Name and Address 1�P l` k_(h City,State and Zipcode M--0\V4 r QEir-f 7 Mailing Address aQ xx i)(, ( City,State and ZipcodeyJVA (AJ114\ ctE5T11 • Washington State 11BI#- f407.-_q3') (off 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 mgv'niolation during any one-year period within the five years preceding the date of the application for a license? NC.) 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. k/ S I certify my statements are true and accurate.My signature authorizes the City of Yelm to verify any information including a driver's abstract. Signature - Date GI_ - - I