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HomeMy WebLinkAbout07-27-10 Council HandoutsOak Park Heights Request for Council Asti. Meeting Date Agenda Item July 27 2010 /approve 2010 Cab Licenses for American Safe & Sober 'rransit 'hinge Req. .0 Agenda Placement Consent Originating Department /Requestoy _ Edna 4 Requester's Signature Action Requested Approve _- sce below ...... n /Jennifer Pinslci I3acicgrotiiicll.l�istilication (Please indicate any previous action has been taken or if' other public bodies have been advised). Nathan Gramicy has made application on behalf of American Safe & Sober Transit to operate a taxi service within the City of Oak Park Heights. The Oak Park heights Police Department has conducted the vehicle inspection, the insura information has been received, and the applicant has paid the appropriate Wee. 1 recommiend approval of the 2010 cab licenses for American Safe & Soper Transit. CITY OF OATS PAIN HEIGHTS APPLICA'T'ION FOR TAXI LICENSE LICENSE YEAR ENDING DECEMBER 31, ` Now Renewal ANNUAL, LICENSE FEE: $60.00 per operator per year - Amount Paid: G Date Paid: APPLICANT INFORMA'T'ION: IN First Middle No Initials) Last Applicant Address City, State, Zip q Applicant Phone Number Applicant Driver's License No, Driver's License Type BUSINESS INFORMATION: r"v e. Business Name Business Address City, State, Zip Business Phone Number Contact Person "VEHICLE DESCRIPTIONS: (add additional sheets as necessary) Failure to supply this info rmation may jeopardize or de the p of yo ur licensing issuanc or renewal a pplication. VEHICLE NO. T Make and Morsel of Vehicle VIN 11 1.w�7 License ]'late No. Seating Capacity VEHICLE NO. 3 Make and Model of Vehicle VIN # VEHICLE' NO.2 Make and del of Vehicle VIN 4. License Plate No. VEHICLE NO. 4 Make and Model of Vehicle VIN 11 Seating Capacity License Plate No. Seating Capacity License Plate No. Seating Capacity DRIVERS INFORMA'T'ION: (add additional sheets as necessary) _ This information will be used to perform a driver's license check. Failure to supply this information may jeopardize or delay th processing of your licensing issuance or renewal app DRIVER NO. I NUJ Q—' First Middle (No Initials) Last J Driver's Address tit , State, Zip Driver's Phone Number Date of Birth . ��' �t �F : i 1,"1 _ `, �'..,: t� K - CS'''C �.� • rc° I� l?,C L� C� ":c' Driver's License No. Driver's License Type DRIVER NO.2 First Middle (No Initials) Driver's Address Driver's Phone Number Last Driver's License No. City, State, Zip / 1 Date of Birth Driver's License Type Page i o1"2 CATS: Insurance File Certificate, .page I of 1 r e v �t4t;z, -yy�S' 7M , f .• •s > File Certificate Cancel Certifica I Re orts I Lod ©ff_ � DMV : I nsurance Filing System File Certificate - Certificate Confirmation Insurer: NATIONAL INDEMNITY COMPANY Status: Active Address: NATIONAL INDEMNITY COMPANY, 3024 HARNEY ST, OMAHA, NE, 68131 Your File Certificate form has been successfully submitted USDOT #: Legal Name: DBA Name: Business Address: Carrier Types: Insurance F'o FORM E Motor Carrier 272853435 FEIN #: GRAMLEY NATHAN AMERICAN SAFE & SOBER TRANSIT 508 PINEWOOD ST AMERY, WI, 54001 HUMAN SERVICE VEHICLE Im: Coverage Type-, Vehicle Coverage: FULL BLANKET Policy Number; 70APS026150 Received: Effective: 07/09/2010 07102112010 Return to Fj.le Certifd.cate Questions about the content of this page Contact Name: WsDOT.Qorr�uto. , []es(c 1 -800- 362 -3050 Last modified: February 01, 2005 https://ti 7/9/2010 M4396 Wisconsin (11192) ATJ&91011 ]11L'11 MN9 Regarding UNINSURED AND /OR UNDERINSURED MOTORISTS INSURANCE The Wisconsin Statute 632,32 requires that Uninsured Motorists Coverage be provided in an amount at least equal to the minimum financial responsibility limits but not greater than the bodily injury liability limits of the policy, in addition, for an additional premium, you may elect to purchase Underinsured Motorists Insurance at limits of liability of at least equal to the minimum financial responsibility limits but not greater than the bodily injury liability limits of the policy. UNINSURED MOTORISTS INSURANCE provides you with protection in the event you are in an accident, through no fault of your own, with another vehicle which was not insured at the time of the accident. The undersigned hereby indicates his choice to purchase Uninsured Motorists Insurance at the following limits: Split Limits of Liability Combined Single Limit $ _100 each person $ u each accident each accident UNDERINSURED MOTORISTS INSURANCE provides you with protection in the event you are in an accident, through no fault of your own, with another vehicle, which, although such other vehicle was insured at the time of the accident, afforded limits of liability lower than the limits afforded by your Underinsured Motorists Insurance limits of liability. E) The undersigned hereby rejects Underinsured Motorists Insurance entirely, r The undersigned hereby elects to purchase Underinsured Motorists Insurance at the following limits: Split Limits of Liability Combined Single Limit C' each person each accident � 0 o, a `` `� each accident MEDICAL PAYMENTS COVERAGE For an additional premium Wisconsin Statute 632.32 further provides coverage for medical payments of chiropractic payments, or both, for the protection of all persons operating or riding in the insured vehicle from losses resulting from bodily injury or death unless this coverage is rejected by the named insured. © The undersigned hereby re_ jects Medical Payments Coverage. Signature of Named Insured (Representing All 3n ureds) fate signed Until you adv otherwise in writing, your choice, as indicated above, will continue regardless of any addition or change in Auto coverage on your current policy or addition of any scheduled Autos and will be carried forward on all future renewal policies without additional notice, M-4396 Wisconsin (91/92)