HomeMy WebLinkAboutRate Card Owner Authorization Statement chg 2016
clerk/Rate Card Owner Authorization Statement chg. Revised 06/2016
RATE CARD AUTHORIZATION STATEMENT
(One statement per business; New rate card must be attached)
Check one of the following:
______ (METER CHANGE) I (We), owner(s) of ______________________________
Taxi Business, desire to change the rate charged as reflected on the attached rate
card and understand that all taximeters for the business must be recalibrated by a
certified calibrator on a form provided by the City and the form returned to the City
Clerk within 10 business days of this filing, in compliance with Title 5, Chapter 2,
Section 8, of the City Code of Iowa City, Iowa.
______ (NO METER CHANGE) I (We), owner(s) of ____________________________
Taxi Business, desire to change the rate charged as reflected on the attached rate
card and understand that, no taximeter calibration is needed. All vehicles will display
the rate card attached within 10 business days of this filing, in compliance with Title 5,
Chapter 2, Section 8, of the City Code of Iowa City, Iowa.
___________________ date due for compliance of ALL vehicles (Must be filed in the
( fill in Due Date) City Clerk’s Office by this date.)
(Statement must be signed by owners representing at least 51% of business)
Date______________ Owner(s)______________________________ (______%)
______________________________ (______%)
State of Iowa )
) SS:
Johnson County )
On this _____ day of ______________, 20____, before me, the undersigned, a Notary Public in
and for said County, in said State, personally appeared
___________________________________________________ to me known to be the identical
person(s) named in and who executed the within and foregoing instrument, and acknowledged
that they executed the same as their voluntary act and deed.
___________________________________
Notary Public in and for the State of Iowa
_____________________________________________________________
OFFICE USE ONLY (to be done ASAP when new rate card filed)
___ New rate card scanned and sent to Equipment with vehicle list (Dan & Darwin with this sheet)
___ City Clerk’s office updates website with revised rate card