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PEDICAB Horsedrawn Decal APP2021Office Use Only DECAL # DATE ISSUED: DATE RETURNED: ___________ APPLICATION FOR PEDICAB/HORSE DRAWN VEHICLE DECAL Fee $ 85.00 Appointment for vehicle inspection must be made between 8 a.m. and Noon, Monday thru Friday at 887-6122 1. Business Name 2. Business Email Address ______________________________________________________________ 3. Business Telephone #: ____________ 4. Name of Office Manager (if any) 5. Vehicle Information: Year: _______________ Make of Vehicle: Serial Number: 6. Attach certificate of insurance for this pedicab/horse drawn vehicle (policy must cover the license period and show a deductible not to exceed $500, with cancellation endorsement) 7. Original of vehicle Inspection must be attached.. I understand that if I falsely answer any of the questions in this application, that 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 a license 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 ___________________________________________________________________________ Owner/Authorized individual (name must be listed on application or authorized statement, respectively) Owner/Authorized individual (name must be listed on application or authorized statement, respectively) ************************************************************************************************************************************************* 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 DECALS WILL BE ISSUED 24 HOURS AFTER COMPLETED APPLICATION RECEIVED BY THE CITY CLERK clerk/PEDICAB HorsedrawnDecal APP 2015.doc