HomeMy WebLinkAboutBusiness APPclerk/taxicompanyapp.doc
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Check appropriate box:
Metered Taxicab Business: ___
Network Taxicab Business: ___
Motorized Pedicab ___ (exempt from May 1 deadline)
TAXI BUSINESS LICENSE APPLICATION – Due by May 1
(Police Department review must be made between 8 a.m. to 3 p.m. Monday – Friday.)
BUSINESS APPLICATION FEE — $20
1. Name of Taxicab Business
2. Business Address
If the office address is in a residential area; one owner must reside at the address.
Email address: _____________________________________ (Email address will be used for notification purposes)
Name of Metered Business Contact: ______________________________________________________________
Name of Network Representative Contact: ___________________________________________________________
3. Business Telephone Number: _________________ Name of Office Manager (if any)
(Emergency phone number should be on file in Police Dept. IF other than business number listed above.)
4. List of names and addresses of all persons having a financial interest in the business thereof. (In the case of a
corporation, LLC, or partnership, all officers, directors, members and persons owning at least a ten percent interest in
the business must be listed.)
% Interest
Name Address (Total should equal 100%)
A.
B.
C.
D. _____________________________________________________________________________________________
*************************************************************************************************************************************************
I have reviewed the application, DCI report, and state certified driver’s records of owners and determined that there is
no information which would indicate that the issuance would be detrimental to the safety, health or welfare of
residents of the City. (Title 5, Chapter 2, City Code)
Police Chief or designee Date
Metered taxicab business address listed above in residential zone? ___ Yes ___ No
Business Owner Name that resides there: __________________________
_____________________________________________________ _________________________________
N.D.S. Date Date
Taxicab Business License is issued to: ______________________________________________________________
Taxicab Business Licenses cannot be sold or assigned.
City Clerk or designee (approved only if color scheme on file) Date
BUSINESS ADDENDUM – OWNER INFORMATION
clerk/taxicompanyapp.doc
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(ONE FOR EACH PERSON LISTED IN ITEM 4 OF BUSINESS APPLICATION)
Business Owner Name _________________________________________________________________________________
Business Owner Address___________________________________City/State/Zip _________________________________
Email address: ___________________________________________ (Email address will be used for notification purposes)
A. Business Owner's prior experience in transportation of passengers:
B. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other _______________
C. Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other _______________
D. Has your driver’s license or chauffeur’s license been suspended or revoked in the last five years? ________________
Type of offense Where When
______________________________________________________________________________________________
______________________________________________________________________________________________
E. DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD
MUST ACCOMPANY EACH ADDENDUM FOR POLICE CHIEF REVIEW FOR EVERYONE LISTED IN ITEM
NUMBER 4.
F. I understand that if I falsely answer any of the questions in this application, this application will be denied. I agree that in
making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to
examine any and all records and documents relating to this application, and I further agree that, if authorization to operate
a taxicab business is granted, to comply at all times with all of the provisions of Title 5, Chapter 2 of the City Code.
(Needs to be signed in front of a Notary Public)
Signature
Business Owner (Must be one of those listed on item 4 of Business application)
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by ____________________________________ on this ___________ day of
_____________________.
________________________________________
Notary Public in and for the State of Iowa