Microsoft Word Taxi Co App.doc

Transcript

1 SAN JOSE POLICE DEPARTMENT PERMITS UNIT All Fees are non -refundable TAXI COMPANY APPLICATION Original Application Renewal Application ***TO BE FILLED OUT BY EACH OWNER*** This Taxi Company Application must be submitted wit h the following information attached: A current copy of the City of San Jose Business Lic ense. • A copy of the insurance policy for the company and • all vehicles verified by Risk Management “additional insured”. Department. The City of San Jose must be listed as • A list of your company phone numbers dedicated to t axi service. One phone line per every eight vehicles. ll, fax numbers) of all owners/managers. • A list of contact phone numbers, (office, pager, ce • A current business financial sworn statement with p rofit/loss itemizations and balances. ity in which business is located • Zoning verification letter from Planning Dept. of c • A list of all San Jose permitted drivers with date of birth, California Drivers License number and expiration date, SJPD driver permit number and expi ration date. A copy of all vehicle registration cards for each S • an Jose permitted taxicab. • A list of all San Jose permitted taxicabs, which in cludes: 1. Year, make and model of vehicles; 2. Company cab numbers; 3. VIN numbers and license plate numbers; 4. Current vehicle mileage for each taxicab. DO NOT STAPLE ANY OF THESE DOCUMENTS TO THIS APPLIC ATION _____________________ TAXI COMPANY NAME ________________________________ 1 – BUSINESS INFORMATION SECTION 1. ____ __________________________________________ Business Name ( as shown on business license) 2. Address ___________________________ City _________ ______________ Zip Code ______________ 3. Phone No _________________________ Fax No. ________ _____________ Cell __________________ 4. Parcel Number ________________________ Zoning of Pr operty ________________________________ 5. _____________________________________ Property Owners Name: ____________________________ Property Owners Address: _________________________ 6. ______________________________________ 7. List each person that has ownership interest in the company; if the company is a corporation, list the name and address of all board of directors, the name and address of the president and secretary. If compan y is a partnership, list names and address of all general ssary). and limited partners (attach separate sheet if nece ___________________________________________________ ____________________________________ ___________________________________________________ ____________________________________ 8. Daily Operations Managers: _______________________ _______________________________________ company _______________________________________ List all experience in the operation of a taxi cab 9. Page 1 of 5 Rev. 4/17/14

2 SECTION 2 - APPLICANT(S) Last Name_____________________________ First_______ 1. _________________ Middle ______________ City_______________ ST____ Zip________ 2. Home Address______________________________________ ____________ Exp. Date: _______________ 3. Approved Government ID with Photo # _______________ Social Security #__________________________________ 4. DOB________________ 5. M olor_______ F HT______ WT______ Hair Color______ Eye C Have you ever been convicted of 6. ANY crime? YES / NO Explain Below Have you ever been convicted of any crime within th e past five (5) years? YES / NO Explain Below 7. 8. ied, suspended, or revoked by any organization? Have you every had a Permit/License of any kind den YES / NO Explain Below Explanation for Questions 6, 7, and 8: __________ ________________________________________________ ___________________________________________________ _______________________________________ ___________________________________________________ _______________________________________ C PPLICANTS O -A 1. _________________ Middle______________ Last Name_____________________________ First_______ 2. Home Address______________________________________ City_______________ ST____ Zip________ Approved Government ID with Photo #________________ 3. Exp. Date: ______________ ___________ 4. Social Security #__________________________________ olor_______ M F HT______ WT______ Hair Color______ Eye C 5. DOB________________ 6. ANY crime or received a criminal citation? YES / NO Explain Below Have you ever been convicted of e past five (5) years? YES / NO Explain Below Have you ever been convicted of any crime within th 7. 8. Have you every had a Permit/License of any kind den ied, suspended, or revoked by any organization? YES / NO Explain Below Explanation for Questions 6, 7, and 8: ___________ _______________________________________________ _______________________________________ ___________________________________________________ _______________________________________ ___________________________________________________ 3 SECTION VEHICLE INFORMATION – 1. Describe the vehicle color(s) and marking to be uti lized on the taxis: ______________________________ ___________________________________________________ __________________________________ this form), give a complete description of each veh icle 2. On the attached Vehicle Inventory sheet (page 5 of , year, VIN number and license number of the vehicl e. to be used. This list must contain the make, model (A minimum of five vehicles is required.) 3. Supply a sworn statement by a state licensed mechan ic that each vehicle has been inspected and is in s afe operating condition. You must also supply a curren t smog, brake and lamp certificate on each vehicle from a state licensed facility and a current meter County of Santa Clara . inspection receipt from the 4. All vehicles must be licensed as commercial vehicle s. The taxi company must be listed on the registra tion as the registered owner. A copy of the registratio n will be attached for each vehicle. 5. List the storage address of all vehicles not stored at the business location: ___________________________________________________ __________________________________ Page 2 of 5 Rev. 4/17/14

3 I HEREBY ACKNOWLEDGE THAT NO TAXICAB WILL BE ALLOWED TO OPERATE ON THE ROAD UNTIL SAID VEHICLE IS INSPECTED AND APPROVED BY THE I OSE P OLICE D EPARTMENT . AN J FURTHER S “ OUT OF SERVICE ” SIGN WILL BE PLACE ON ALL VEHICLES NOT IN USE AS ACKNOWLEDGE THAT AN REQUIRED BY THE AN J OSE M UNICIPAL C ODE . S ___________________________________________ ________________________________ S DATE IGNATURE 4 – OPERATION SECTION the taxi company including: Location of dispatch f acilities, Complete a description of the proposed operation of n and FCC call letters of the dispatch facility, an d how the location of radio transmitter/receiver, the locatio business is to be operated. List the number of tel ephone answering lines and location where such tele phone answering lines will be answered. ___________________________________________________ _______________________________________ ___________________________________________________ _______________________________________ ___________________________________________________ _______________________________________ ___________________________________________________ _______________________________________ 5 SECTION – FINANCIAL STATEMENT Attach a sworn financial statement showing the name s of all parties investing in the taxi company and/ or all sources or proposed financing. SECTION 6 – INSURANCE A duplicate copy of the insurance policy as require be d by San Jose Municipal Code Section 6.64.450 must supplied to the City’s Risk Management Department f or approval. If the policy is contingent on the po lice approval of the company permit, a written statement of intent from the insurer that such insurance pol icies issued will be given to the Police Department. I certify under penalty of perjury that the stateme nts made on this application are to the best of my knowledge, true and correct. I also acknowledge th at I have read and understand the City Taxi Cab Ordinance beginning with section 6.64.010 of the Sa n Jose Municipal Code. _ Signature _________________________________________ Date _______________________________ Page 3 of 5 Rev. 4/17/14

4 DO NOT COMPLETE THE SECTION BELOW - FOR SJPD VERIFI CATION USE ONLY Business Lic. No ___________ Exp. _________ Total N umber of Cabs _____________ CDL No. ______________________________ Acct. No. _________________________ Citizenship _____________________________ Company P hone Nos. __________________ Insurance Policy No. ___________ Exp. ______ Contac t Nos. _________________________ Taxicab Driver Information _____________ Risk Management Verification ______________ Planning Zoning Confirmed ________________ Taxicab Vehicle Information ____________ ial Statement____________________ Sent for Fingerprints: _____________________ Financ Permit Exp. Date: ________________________ Receipt No./Clerical: ___________________ SJPD APPROVAL: DATE: _______________________________ _______ NAME _____________________________ BADGE NO. _____ Page 4 of 5 Rev. 4/17/14

5 SAN JOSE POLICE DEPARTMENT PERMITS UNIT VEHICLE INVENTORY LIST TAXI COMPANY NAME: _______________________ DATE: __ ____________________ YEAR MODEL VIN NO. LICENSE MILEAGE MAKE CAB NO. Page 5 of 5 Rev. 4/17/14

Related documents