HomeMy WebLinkAboutPEDICAB 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