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HomeMy WebLinkAbout181-12 RESOLUTIONRESOLUTION NO. 181-12 A RESOLUTION GRANTING A CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY TO FAYETTEVILLE TAXI LC FOR THE OPERATION OF ONE (1) TO FOUR (4) TAXICABS IN THE CITY OF FAYETTEVILLE WHEREAS, the City Council of the City of Fayetteville, Arkansas finds that further taxicab service in the City is required by the public convenience and necessity; and WHEREAS, the City Council of the City of Fayetteville, Arkansas, taking into consideration the number of taxicabs already in operation, whether existing transportation is adequate to meet the public need, the probable effect of increased service on local traffic conditions and the character, experience, and responsibility of the applicant, finds the applicant, Fayetteville Taxi LC is fit, willing, and able to perform such public transportation and to conform to the provisions of Article IV of Chapter 117 of the Fayetteville Code of Ordinances; NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the City Council of the City of Fayetteville, Arkansas hereby grants a Certificate of Public Convenience and Necessity to Fayetteville Taxi LC for the operation of one (1) to four (4) taxicabs in the City of Fayetteville, in accordance with Article IV of Chapter 117 of the Fayetteville Code of Ordinances. PASSED and APPROVED this 4th day of September, 2012. APPROVED: ATTEST: By: SONDRA E. SMITH, City Clerk/Treasurer ow1111f// Y • FAYETTEVILLE: .". %v�,y7/CA NSP�••�'��� Mike Reynolds Submitted By City of Fayetteville Staff Review Form City Council Agenda Items and Contracts, Leases or Agreements 9/4/2012 City Council Meeting Date Agenda Items Only Police Division Action Required: Police Department Request for public hearing to determine if a Certificate of Public Convenience and Necessity should be issued to Fayetteville Taxi LC. N/A Cost of this request N/A Account Number N/A Project Number N/A Category / Project Budget N/A N/A Program Category / Project Name N/A Funds Used to Date Program / Project Category Name N/A N/A Remaining Balance Fund Name Budgeted Item Budget Adjustment Attached 08 /7,20/2 Previous Ordinance or Resolution # Departnt Director lat :2.. 7g1//,--6---- F-20-12-- Date ity Attorney ina ce and Inter I Services Director Date Original Contract Date: Original Contract Number: Received in Csitj- i 7-12P01:1:) Clerk's Office 1 Received in Mayor's Office 20/(2 Comments: (7X° Ap 5-rrt -•e 1.40A- .ku.4A.c 0 AAA/ an Com, �:•�1 Revised January 15, 2009 Ta'e leville THE CITY OF FAYETTEVILLE, ARKANSAS POLICE DEPARTMENT 100-A West Rock Street Fayetteville, AR 72701 P (479) 587-3555 F (479) 587-3522 ARKANSAS www.accessfayetteville.org TO: Mayor Lioneld Jordan and Members of the City Council FROM: Mike Reynolds, Deputy Chief of Police DATE: August 17, 2012 RE: Request for Public Hearing on a Certificate of Public Convenience and Necessity for Fayetteville Taxi LC Recommendation: The council should schedule a public hearing to determine if a Certificate of Public Convenience and Necessity should be issued to Fayetteville Taxi LC. Background: City Ordinance 117 article IV governs taxicabs and requires a public hearing to determine if there exists the further need for taxicab service. Discussion: Attached are copies of Mr. Larrabee's application for his certificate, proof of insurance and financial statement. Budget Impact: None. Telecommunications Device for the Deaf TDD (479) 521-1316 113 West Mountain - Fayetteville, AR 72701 RESOLUTION NO. A RESOLUTION GRANTING A CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY TO FAYETTEVILLE TAXI LC FOR THE OPERATION OF ONE (1) TO FOUR (4) TAXICABS IN THE CITY OF FAYETTEVILLE WHEREAS, the City Council of the City of Fayetteville, Arkansas finds that further taxicab service in the City is required by the public convenience and necessity; and WHEREAS, the City Council of the City of Fayetteville, Arkansas, taking into consideration the number of taxicabs already in operation, whether existing transportation is adequate to meet the public need, the probable effect of increased service on local traffic conditions and the character, experience, and responsibility of the applicant, finds the applicant, Fayetteville Taxi LC is fit, willing, and able to perform such public transportation and to conform to the provisions of Article IV of Chapter 117 of the Fayetteville Code of Ordinances; NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the City Council of the City of Fayetteville, Arkansas hereby grants a Certificate of Public Convenience and Necessity to Fayetteville Taxi LC for the operation of one (1) to four (4) taxicabs in the City of Fayetteville, in accordance with Article IV of Chapter 117 of the Fayetteville Code of Ordinances. PASSED and APPROVED this 4th day of September, 2012. APPROVED: ATTEST: By: By: LIONELD JORDAN, Mayor SONDRA E. SMITH, City Clerk/Treasurer (8/20/2012) Jason Kelley Fayetteville Taxi LC _� Page1T From: Jason Kelley To: Harter, James; Reynolds, Mike Date: 8/20/2012 12:01 PM Subject: Fayetteville Taxi LC CC: Smith, Sondra; Williams, Kit I have reviewed the agenda item sent through on the Certificate of Public Convenience and Necessity for Fayetteville Taxi LC filed by Stewart Larrabee. There are some deficiencies in the application. First, by ordinance, the application is to be verified under oath before a Notary (Fayetteville Code § 117.32(B)). This application form does not have that. Harter signed it, but that is unnecessary, and I recommend against us doing that. (It very well might be that our form is out of date and needs a revision, but I am looking at our current ordinance requirements and the application form as submitted.) Second, the applicant says the minimum number of vehicles to be permitted is "1" with a maximum number of vehicles being "4+". I do not believe this is responsive in that "4+" could be anywhere from 4 to any number higher than that (really no limit). That will be an issue for the Council to decide. Third, proof of current insurance will have to be shown before the City Clerk can issue the certificate, even if approved by the Council The insurance must contain a cancellation provision in which the insurance company is required to notify the city in writing not fewer than 30 days before cancelling, failing to renew, or making a material change to the insurance policy. The application contains an insurance quote and a finance agreement for the premiums, but proof of actual coverage will still be required before a certificate can be issued. I will go ahead and prepare a resolution for the Council to consider, but it is my opinion that Fayetteville Taxi LC needs to have their application notarized before it can be considered. If you have any questions, let me know. Jason K. Jason B. Kelley Assistant City Attorney City of Fayetteville, Arkansas 113 W. Mountain St., Suite 302 Fayetteville, Arkansas 72701 Telephone (479) 575-8313 Facsimile (479) 575-8315 Email: ikellev©ci.favetteville.ar.us Website: www.accessfavetteville.orq ( http://www.accessfayetteville.orq/ ) Certificate of Public Convenience & Necessity Application/Renewal Aa required to comply with Chapter 117 of the Fayetteville Code of Ordinances Zs at c.), , r ao.s7ro,c7 gd i 0 e41R147- 4471 Q$4EYETTEI/«-- 7270y 7s5- 3Z9-796/ Applicant Name Address Phone Number AvE7r vitt 7i L� 12rn-/ Aan8& rev,PiA/ Name of Business Phone Number 7 0r1D -D A14)Nnrum lD LotgTiaAe l'910,,,/c. -/F A/E 7 I) Business Location 2622 ti, 047, gM ir' I L77 iO , K,¢yc- 'vit-tC� AR_ -7-.Alt. Mailing Address 4c(EITLLt)Type of Business (Sole Proprietor, CorporateLC) Name and address of all owners, officers and stockholders: /.51,)rnc 4 11-21€ ek_ Name of person to whom complaints should be directed: J/eartn% Z.44-7e/2715.6-6- r4'Ie/271'rj -Financial Financialstatus of applicant (Attach financial statement or profit and loss statement) rfeWie0 List any unpaid Judgments against any of the owners, officers and stockholders and the nature or acts giving rise to said Judgments: kAkna 06.eoie- - ><Y v«t.e- T.;:hr Le Nal) C0011,1-Ny. Describe the experience of all owners, officers and stockholders In the transportation of passengers: PA') vex- fri %%y v4 7 7 (J z.itsr ye -4--c. 40t»LR M.0 . -/P6740... 6 ' 1 Seetsov (,ZCe-Af CA -8 Co . -7764-7-( rexpoRAe7 liE)417 P 141AlLe ff'"i GVnr uc,r/on/ ne4 3 AN4"GEL1 ,61/ Mt . Give any facts you believe tend to prove the necessity of granting a certificate: :CNA) eLfrtotTwry tJ 1.4- 8E' Pion 2 t P T airy 00o,v e- L. /Al Fi--X4 Al /3/660 on/ &q-5/ 6-5/ Cti5lb/he - 6e721/ray � i?EI?0ENer/ /Ivo ariteNf o,(,v yzot /. 5,0 me- id i.trrew S o rape) rzi /g -7 -77i -144/E -D. (77eL5 of TM 1 t,?g 4 CHRIS Vi -g66 Ts1R,D List the number of vehicles that will be under your operation or control: Minimum and Maximum number of vehicles to be permitted: List the location of proposed depots and terminals: VitCkle. h I..ALA?IoKS ft5 A/E&O/N 7H9 &iVT0C.�/97idM‘la- 1i15721irT'— 1NewaJ4Ik fJcr<5oN e T fir ,S X700Jtrdont ,,n�,l�� THE. 1i. 2 rl u• Minimum Maximum Describe the color scheme or insignia to be used to designate yourvehicle: hio/vvrt f 771E-' /kif"Zort-anc-ic �E� j� hilt/%F I nticeNGs l List your days and hours of operation: P.N.-K/465 /its de--&-?fer71 6,017t.%171 OF Avficimi-e1%/ thva 61Zoomec, Ta 841 M > • C:.v 4-c_ -ve.747-5 Ust any days you do not propose to provide taxicab service to the general public: -123 p - G'f zi r-ivrfiS .l //ot'esat.1 tjru. 3e o�-ea�c k , List your proposed passenger rate schedule: car R. - C1r 57.074Aexii, oiicbpartment Representative Date August 13, 2012 To the City of Fayetteville, Mr. Tim Farrell of Farrell's Lounge supports the need for additional Taxicab Operators in Fayetteville, as the current wait -times during the off-peak season are excessive. Mr. Larrabee has been a driver at another Taxi Company and has personally provided myself quality service and should be given the opportunity operate his own company. Sincerely, Mr. Tim Farrell August 13, 2012 To the City of Fayetteville, Mr. Chris Varga of Sideways supports the need for additional Taxicab Operators in Fayetteville, as the current wait -times during the off-peak season are excessive along with poor customer service by some of the current providers. Mr. Larrabee has been a driver at another Taxi Company and has personally provided myself quality service and should be given the opportunity operate his own company. Sincerely, Mr. Chris Varga Fayetteville Taxi LC Stewart Larrabee 2556 W Mt Comfort Rd, #10 Fayetteville, AR 72704 August 16, 2012 City of Fayetteville Attn: Sgt. Harter 100 W Rock St Fayetteville, AR 72701 Please accept this letter as a financial statement on behalf of Fayetteville Taxi LC with the pending taxi operators permit application(s). Fayetteville Taxi LC is a brand new entity and is an Arkansas limited liability company (copy attached). Fayetteville Taxi LC and/or Stewart Larrabee have no known judgment(s). Sincerely Stewart Larrabee Fayetteville Taxi LC S ,, TATE DSAS Mark Martin ARKANSAS SECRETARY OF STATE To All to Whom These Presents Shall Come, Greetings: I, Mark Martin, Arkansas Secretary of State of Arkansas, do hereby certify that the following and hereto attached instrument of writing is a true and perfect copy of Articles of Organization of FAYETTEVILLE TAXI LC filed in this office August 14, 2012. In Testimony Whereof, I have hereunto set my hand and affixed my official Seal. Done at my office in the City of Little Rock, this 14th day of August, 2012. Arkansas Secretary of State Fayetteville Taxi LC August 16, 2012 Note regarding insurance coverage: The current attached quote is showing 300/300/300 for base coverage, which exceeds the required coverage of 25/50/25. The attached quote shows that the entity is insurable. Current proof of coverage is already required to be submitted to the City before any taxi company starts providing services, along with vehicle inspections and verification of appropriate approved drivers and the like. Other insurance quotes are pending as this quote is a bit overpriced. If a different underwriter is ever chosen by Fayetteville Taxi LC, proper timely submission will occur to the City of Fayetteville and will always meet any minimum requirements including the required 30 day cancelation notice. Sincerely Stewart Larrabee Fayetteville Taxi LC INSURANCE QUOTATION THE TERMS AND CONDITIONS OF THIS QUOTATION MAY NOT COMPLY WITH THE SPECIFICATIONS SUBMITTED FOR CONSIDERATION. PLEASE READ THIS QUOTE CAREFULLY AND COMPARE IT AGAINST YOUR SPECIFICATIONS. IN ACCORDANCE WITH THE INSTRUCTIONS OF THE BELOW -MENTIONED INSURER, WHICH HAS ACTED IN RELIANCE UPON THE STATEMENTS MADE IN THE RETAIL BROKER'S SUBMISSION FOR THE INSURED, THE INSURER HAS OFFERED THE FOLLOWING QUOTATION. DATE ISSUED: August 15, 2012 PRODUCER: INSURED: AARON ADAMS, INC #901425 3075 NORTH MARKET AVENUE SUITE 1 Fayetteville, AR 72703 Stewart Larrabee dba: Fayetteville Taxi LC 256 W. Mt. Confort Road #10 Fayetteville, AR 72704 COVERED LOCATION: 256 W. Mt. Confort Road #10, Fayetteville, AR 72704 INSURER: National Liability & Fire COVERAGE: Business Auto POLICY PERIOD: 8/15/2012 TO 8/15/2013 TERM: 365 12:01 A.M. STANDARD TIME AT THE LOCATION ADDRESS OF THE NAMED INSURED. THIS INSURANCE QUOTATION WILL BE TERMINATED AND SUPERSEDED UPON DELIVERY OF THE FORMAL POLICY(IES) ISSUED TO REPLACE IT. LIMITS: DEDUCTIBLE: 300,000 csl Liability 300,000 csl UM/UIM bi only 300,000 csl UMPD $5,000 s/v 2001 Ford Windstar - 7 passangers 100 Mile - Taxi Service - based on 1 driver 48 Clean driving record Subject to: fully completed signed company application, Company acceptable MVR on each driver and NO losses prior to binding 500/500 Comp/Coll each & every claim and unit PREMIUM: $4,989.00 FEES: $200.00 Fully -Earned TOTAL: $5,189.00 Subject to a REQUIRED 32 day cancellation from receipt date of request on ANY policies with DOT Filings or State Certificates Issued. NOTE: Policies are bound by receiving either a fax or email of completed application, or postmark of application and bind request. This premium quoted reflects underwriting information received and is valid subject to company approved MVR's, Inspection and completed signed application. The quoted premium is based on the information currently in the file; the premium may change upon receipt of any new or additional information. TERMS / CONDITIONS: (a) 25% OR $250.00 (WHICHEVER IS GREATER) MINIMUM EARNED PREMIUM AT INCEPTION. NO FLAT CANCELLATIONS (b)ENDORSEMENTS / NOTABLE EXCLUSIONS: (c) ATTACHMENTS / SUBJECT TO: Strict Radius *In order to bind coverage we must receive a request in writing. No agent has the authority to bind coverage. Notice to your agency is NOT notice to M J Kelly. *Subject to a complete signed , and dated application upon binding *It is expressly understood and agreed by the insured by accepting this .instrument that M J Kelly is not an insurer and shall not be liable in any way nor to any extent for any loss or claim. *ANY EMPLOYEES HIRED DURING THE TERM OF THIS POLICY MUST BE REPORTED TO MJ KELLY. THIS INCLUDEDS BOTH DRIVING AND NON DRIVING EMPLOYEES. *Subject to no undisclosed losses *Renewal is Subject to No Changes in Exposure for this Risk. It is your responsibility to confirm with the insured if there have been any changes and advise us of any changes in the risk. *Subject to acceptable Company ordered Inspection *Unreported drivers may jeopardize coverage *The underwriter reserves the right to amend or withdraw terms upon review of information. *In order to bind coverage we must receive a request in writing. No agent has the authority to bind coverage. * Any Driver under the age of 21 must be excluded. Any Driver under the age of 25 must be approved by the company, prior to adding to policies. $ Coverage will be bound effective the date of you agency check or ACH payment is received in our office, subject to funds clearing. (d) ALL OTHER TERMS AND CONDITIONS APPLY PER FORM COMMISSION: 9% THIS QUOTE IS ISSUED BASED UPON THE INSURER'S AGREEMENT TO QUOTE AND IS ISSUED BY THE UNDERSIGNED WITHOUT ANY LIABILITY WHATSOEVER AS AN INSURER. THIS QUOTE MAYBE WITH -DRAWN BY THE INSURER AT ANY TIME PRIOR TO BINDING. NO AGENT HAS BINDING AUTHORITY. THIS QUOTE IS VALID FOR THIRTY DAYS FROM THE DATE OF ISSUE. AUTHORIZED REPRESENTATIVE Rhonda Branum X 115 This quotation shall confer upon the Producer no authority, expressed or implied, to bind or obligate MJ Kelly Company in either respect. It is understood that according to the producer agreement, that no insurance submitted for consideration is effective until acceptance is indicated in writing or a policy or binder is issued by MJ Kelly Company. TOTAL NUMBER OF PAGES: 2 INSURED: Stewart Larrabee DATE ISSUED: August 15, 2012 Reference #:0314653 Finance Agreement M. J. KELLY COMPANY PO Box 231 Turners, MO 65765 Phone: 417-883-2688 Fax: 417-883-7103 INSURED: Stewart Larrabee 111 Fayetteville, AR 72704 0000000000 QUOTE # 0314653A.1 AGENT: Aaron Adams, Inc 3075 NORTH MARKET AVENUE SUITE 1 Fayetteville, AR 72703 479-443-5050 POLICY NUMBER INSURANCE COMPANY OR GENERAL AGENT EFFECTIVE DATE TERM COVERAGE TYPE PREMIUM TBD National Liability & Fire 8/15/2012 12 Automobile $5,189.00 17.5% In consideration of the payment by M. J. KELLY COMPANY of the AMOUNT FINANCED of the premium described above for my account and on my behalf, I hereby accept the following terms and conditions. (Continued on Page 2) The finance charge includes a setup fee of $15.00 CREDITOR M.J. KELLY COMPANY SECURITY: You are giving a security interest in the unearned premium funds due under the policy being purchased LATE CHARGE: If a payment is late, you will be assessed a late charge. For additional information about late charges, see item 19 on page 2 of this agreement PREPAYMENT, NON-PAYMENT AND DEFAULT: If you pay off early, you may be entitled to a refund of part of the fmance charge, although you may have to pay a pre -payment penalty. See page 2 of this document for any additional information about non-payment, default and prepayment refunds and penalties. YOUR PAYMENT SCHEDULE WILL BE: J NUMBER OF MONTHLY PAYMENTS Ai TOTAL PREM —� TAXES, FEES B CASH DOWN AYMENT (TOTAL DOWN PAYMENT) C I AMOUNT FINANCED Amount of credit provided to you or on your behalf. D—� FINANCE CHARGE The dollar amount the credit will cost you LII TOTAL OF PAYMENTS The amount you will have paid after you have made all payments F I INTEREST RATE $5,189.00 $1,597.00 $3,592.00 $281.87 $3,873.87 17.5% The finance charge includes a setup fee of $15.00 CREDITOR M.J. KELLY COMPANY SECURITY: You are giving a security interest in the unearned premium funds due under the policy being purchased LATE CHARGE: If a payment is late, you will be assessed a late charge. For additional information about late charges, see item 19 on page 2 of this agreement PREPAYMENT, NON-PAYMENT AND DEFAULT: If you pay off early, you may be entitled to a refund of part of the fmance charge, although you may have to pay a pre -payment penalty. See page 2 of this document for any additional information about non-payment, default and prepayment refunds and penalties. YOUR PAYMENT SCHEDULE WILL BE: J NUMBER OF MONTHLY PAYMENTS J AMOUNT OF EACH PAYMENT li PAYMENTS ARE DUE FIRST PAYMENT DUE 9 $430.43 Monthlyon 15th 9/15/2012 ITEMIZATION OF AMOUNT FINANCED: IN "1'li1S AteEH_H MH:NT, : THE UNDERSIGNED AGREES TO THE PROVISIONS ABOVE AND ON PAGE 2 NOTICE: A. DO NOT SIGN THIS AGREEMENT BEFORE YOU READ IT OR IF IT CONTAINS ANY BLANK SPACES B. YOU ARE REQUIRED TO RECEIVE A COMPLETELY FILLED IN COPY OF THE AGREEMENT. C. YOU HAVE THE RIGHT TO PAY OFF IN ADVANCE THE FULL AMOUNT DUE AND UNDER CERTAIN CIRCUMSTANCES TO OBTAIN A PARTIAL REFUND ON THE FINANCE CHARGE. THE UNDERSIGNED EXECUTED THIS AGREEMENT AND RECEIVED A COPY THEREOF SIGNATURE OF WITNESS/AGENT DATE SIGNATURE OF INSURED/APPLICANT AGENT / BROKER WARRANTY The undersigned hereby warrants that (1) the policies are in full force and effect (2) the insured has received a copy of this agreement (3) the above note is valid and correct and represents a bona fide transaction (4) the undersigned appoints M. J. KELLY COMPANY or its agent its Attorney -in -Fact to do every act or thing necessary to collect and discharge the same, and to demand and collect any premiums on account of cancellation of the said policy(ies) (5) no policy(ies) are non -cancellable, subject to retro- spective rating or subject to special cancellation provisions other than indicated in this agreement (6) all unearned commissions, premiums and dividends will be returned to M. 3. KELLY COMPANY. As collateral security for the payment of this obligation the party executing this Agreement agrees as follows: 1. Assigns to hold (and otherwise grants a lien to holder) all rights to return premiums which may in any manner become payable to or under the policies listed on the Agreement (subject, however to any prior perfected mortgages or loss payee interest). The holder hereof shall first apply any such payments to satisfy the amount due under this Agreement interest or late charges as may be provided herein and/or as are allowed by law and, except as to Illinois insureds, attorneys' fees and court costs as may be allowed by law, and remit any surplus then remaining to the party executing this Agreement at the address given hereon or to the agent -broker, in which said event holder shall have no further responsibility for the application of funds between the agent -broker and the buyer -insured, only such responsibility or dispute to be solely between the agent -broker and the buyer -insured and if be any deficiency, buyer -insured to responsible to holder for same. The obligation of any insurance company shall be fully satisfied by it making such payment to the holder, and it shall have no responsibility to see to the proper application of any such surplus, said duty remaining solely that of holder. 2. The party executing this Agreement shall not assign or otherwise encumber (except as may be provided herein) the poloicies listed herein, during the term hereof, and agrees that holder may correct typographical and computational errors without notice, provided that such corrections are in accordance with standard rates of holder. 3. In the event of any default in the payment of any installment due hereunder or in the event of an assignment without the consent of the holder hereof or if the property insured is sold, or if the party executing this Agreement becomes insolvent or be declared bankrupt, or in the event of the death of the party executing this Agreement, such happening, default or breach shall be deemed an election on the part of the party executing this Agreement and/or his estates to cancel the policy/policies, and the holder, at his or its election, after giving the buyer -insured notice that said policy/policies will be cancelled, is neither authorized to notify the insurance company/companies shall make such payment direct to said agent -broker provided that such notice is accompanied by such organization of assignee. 4. In the event of the cancellation of the policy/policies by the insurance company/companies or any of then the return premium/premiums shall be paid direct to the holder hereof. If holder receives any payments from buyer -insured after cancellation procedures have been initiated or effected, holder at this option 1) may collect all past unpaid delinquincy charges, and attempt to stop such cancellation or attempt to reinstate such policy (but shall have no responsibility for accomplishing such result), and if cancellation is stopped or the policy is reinstate shall so notify buyer -insured, or 2) may, without further notice apply said payment to any balance owing buyer-insured's account with FINANCE COMPANY without attempting to stop such cancellation or without attempting to reinstate said policy. 5. In the event the policy/policies are cancelled, the insurance company/companies are authorized and instructed to issue checks solely to holder of this Agreement, except as provided in Paragraph 3 hereof. 6. In the event a loss or losses are suffered under the policy/policies before all installments have been paid, then proceeds payable under the policy/policies shall be applied to the payment of the balance hereon and any check issued therefore by the insurance company/companies are authorized to so issue such checks without obligations as to application of proceeds. 7. If any of the insurance company/companies listed herein are declared insolvent of subject to receivership proceedings or placed in receivership or if holder shall in good faith feel insecure as to the financial or other legal status of one or more of the listed insurance companies, then the full amount payable hereunder shall as holder's option become forthwith due and payable without notice and the holder shall have the right to cancel said policies and persue any and all of its other rights under this Agreement and particularly Paragraphs 3 and 6 hereof. 8. Buyer -insured and all endorsers hereof waive presentment for payment, demand, protest, and notice of protest. 9. Buyer -insured releases and discharges and agrees to hold harmless the holder hereof and his or its agents, officers, employess, and assignees from liability or cause of action by reason of any cancellation made or notified or pursuant to provisions hereof. 10. No waiver by any holder shall be construed as a waiver of any other or subsequent default nor affect any rights incident thereto. No assignee of original holder shall be under any liability hereunder as an insurer or as an agent or employee of an insurer. The entire agreement between parties hereto is contained herein and there are no other conditions, provisions, understanding, or undertakings. This Agreement has been executed in the state of residence of FINANCE COMPANY, as indicated in the address section of this Agreement, and shall be construed under the laws of that State. 11. Buyer -insured agrees that the surrender of the policies shall not be necessary to entitle the holder to receive any return premiums or proceeds of loss and hereby authorizes each of the insurance companies to pay to holder all such retum premiums and proceeds of loss proceeds of loss otherwise payable hereunder without requiring the surrender of any policy or certificate. But buyer -insured expressly agrees upon of holder at any time during the hereof to immediately forward such policies to holder, and failure to so forward after request of holder shall be a default subject to all of the rights provided for in Paragraph 3 hereof. 12. Buyer -insured agrees that no agent or broker soliciting and/or writing any of said policies was or is agent of any assignee hereof, all such agents or brokers having acted solely as agents of buyer -insured or of the insurance companies. No acts, representations, promisies, or warranties of any such agents or brokers with respect to this contract or any of said policies shall be binding upon any assignee hereof. 13. Any notice mailed by holder to buyer -insured at the address given hereon shall be suffecient notice, but this provision shall in no way be deemed or construed to require the giving of any notice not specifically provided for herein, and all rights and notices shall be of equal effect and notice to other persons who may be insured on any such policy in addition to the insured. 14. The term holder when used herein shall include within it meaning any assignee of the original holder. 15. If any of the terms hereof are against the public policy of the law of the applicable state, then such forms should be of no force or effect, provided however, the remainder of this Agreement shall continue to be of full force and effect. 16. Interest accrues from the earliest date policy financed hereunder. A change shall be made in addition to all other charges for processing cancel- lation of the insurance policies financed hereunder. 17. A check retumed to holder by the insured's bank for any reason, shall be deemed a default by the insured and the holder shall have the right to cancel all policies financed hereunder, and persue any all of its rights under this Agreement, particularly Paragraph 3 hereof. The holder may charge the insured a special service fee for the handling of returned checks. 18. The buyer -insured hereby irrevocably appoints FINANCE COMPANY ATTORNEY IN FACT and grants to FINANCE COMPANY full authority to effect cancellation of said policies and to receive and receipt for all sums assigned to FINANCE COMPANY until such time that the entire amount due is paid. Any such sums shall be credited to said amount due and surplus shall be paid to the buyer -insured. In the event of deficiency, the buyer -insured agree to pay the same, with interest. 19. When installments are not paid when due, late charges shall be made on all instalhnents at the rate of 5% of the delinquent installment with a minimum late charge of $10.00 on each delinquent installment. NOTICE: SEE FIRST PAGE FOR IMPORTANT INFORMATION If your account goes into cancellation status, we will charge a $15.00 fee. Schedule H AUTHORIZATION AGREEMENT DIRECT PAYMENTS (ACH DEBITS) I (we) hereby authorize , hereinafter called COMPANY, to debit entries to my (our) account indicated below and the Financial Institution named below, hereinafter call FINANCIAL INSTITUTION, to debit same to such account. I (we) acknowledge the origination of ACH transactions to my (our) account must comply with the provisions of U S. law 1 understand that my signature authorizes a one time non-refundable $20.00 setup fee (Financial Institution Name) (Branch) (Address) (City -State) (Zip) Type of Acct: Checking Savings (Routing/Transit Number) (Account Number) This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and manner as to afford COMPANY and FINANCIAL INSTITUTION a reasonable opportunity to act on it. (print individual name) (pint individual name) (print individual ID number) (print individual ID number) (Signature) (Signature) (Date) PLEASE ATTACH COPY OF VOIDED CHECK TO THIS FORM (Customer retains second copy) The Signature Bank Revised 2005 14 National Indemnity group of insurance companies Columbia Insurance Company National Fire & Marine Insurance Company National Liability & Fire Insurance Company National Indemnity Company National Indemnity Company of the South National Indemnity Company of Mid-America Public & Special Types Application Review the application for accuracy. * denotes information that needs to be completed. 1. Policy Term 08/15/2012 - 08/15/2013 2. Named Insured Stewart Larrabee * 3. DBA 4. Entity Type ® Individual ❑ Partnership ❑ Corporation ❑ Other * 5. Business Phone Number Email Address * 6. Mailing Address Website 7. City Fayetteville * 8. * 9. City State Zip * 10. Premises Address State AR Zip 72704 ❑ Yes ❑ No Have you ever had insurance with one of the companies listed above? Coverages Liability $300,000 Combined Single Limit Uninsured & Underinsured Motorist $300,000 Combined Single Limit Medical Payments Not Purchased Operations 11. * 12. Vehicle Usage *13.❑Yes ❑No *14. 1:1 Yes No 15. Q Yes ❑ No * 16. 17. ® Yes ❑ No * 18. *19. El Yes *20. ❑Yes *21. El Yes *22. ❑Yes * 23. ❑ Yes *24. ❑Yes Business Description Taxi Service New Venture? Years experience Is this your primary business? If no, explain Is your business for hire/for profit? Gross receipts last year Do you operate in more than one state? If yes, list states What is the largest city entered? Estimate for coming year ❑ No Is the transportation of people your primary business? ❑ No Are vehicles leased to drivers? ❑ No Do you transport physically disabled individuals? If yes, what percentage of the time? ❑ No Are vehicles equipped with a fare box or meter? If yes, which vehicles? ❑ No Do you have a scheduled route? ❑ No Do you ever transport unscheduled passengers? Ambulance and Medical Transportation 25. ❑ Yes 26. ❑ Yes 27. ❑ Yes 28. 29. Driver Training 30. ❑ Yes ❑ No 31. ❑ Yes ❑ No 32. ❑ Yes ❑ No Loss Experience * 33. DYes ❑ No ❑ No ❑ No ❑ No * 34. ❑ Yes ❑ No M-5689 (0212012) Do autos without lights and sirens have lifts, ramps or wheelchair tie downs? If yes, which autos? Are any autos operated 24 hours per day? If yes, which autos? Are you the primary response unit for emergency (911) calls? What percent of your ambulance dispatches are Emergency (Code 3 or 4)? What percent of your ambulance dispatches are Non -Emergency (Code 1 or 2)? Is operation part of a school curriculum? Is class room instruction given? Are autos equipped with dual controls? If no, which autos do not have dual controls? Have you ever been declined, canceled or non -renewed for this kind of insurance? If yes, explain Have you previously had commercial auto insurance? If yes, name of prior insurance company Number of accidents in the past 3 years Include loss runs or provide details of losses Drivers * 35. ❑ Yes ❑ No Are drivers covered by workers compensation? Vehicles Year, Make, Model VIN Accidents and Minor Moving Traffic Violations in Past 3 Years License Experience Name Date of Birth State Number Type Type of Unit # of Years 1Stewart Larrabee 100 AR 2 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 8 8 * 35. ❑ Yes ❑ No Are drivers covered by workers compensation? Vehicles Year, Make, Model VIN Accidents and Minor Moving Traffic Violations in Past 3 Years Major convictions (DWI/DUI, hit & run, reckless, driving while suspendedlrevoked) Name #of Accidents Date(s) #of Violations Date(s) Describe conviction Date(s) 1 Stewart Larrabee 500 100 2 2 2 3 3 4 4 4 5 5 6 6 7 8 * 35. ❑ Yes ❑ No Are drivers covered by workers compensation? Vehicles Year, Make, Model VIN Body Style (Taxi, Ambulance, Hearse, etc.) Original Mfg Seating Capacity Garaging Address Radius Annual Mileage Length of Stretch (Limo) Emergency Lights & Sirens (S), Wheelchair Equip. (W) 1 2001 FORD WINDSTAR Other - Taxi 7 500 100 2 2 3 3 4 4 6 5 6 *Include the value of AN equipment permanently installed in the vehicle M-5689 (02/2012) Physical Damage Loss Payee (L) or Additional Insured -Lessor (A) Veh. # Stated Amount Comp (C) Spec (S) CIS Ded. Collision Ded. 1 5,000 C 500 500 2 3 4 5 6 *Include the value of AN equipment permanently installed in the vehicle M-5689 (02/2012)