1. | Applicant:_________________ | ( ) Natural person(s) |
| | ( ) Corporation |
| | ( ) Partnership |
| | ( ) Other _________________ |
| | (Specify) |
2. | Business address: _____________________________________________________ |
3. | If applicant is a corporation: |
| State of incorporation ___________________________________________________ |
| Officers: | President ____________________ |
| | Vice President ________________ |
| | Secretary ____________________ |
| | Treasurer____________________ |
| Directors | |
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| Shareholders (and percent interest of each shareholder): |
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| If applicant is a Rhode Island Corporation, attach a certificate of good standing from the Rhode Island Secretary of State. If applicant is a foreign corporation, attach a certificate of good standing from the state of incorporation and a certificate of authority to transact business in Rhode Island from Rhode Island Secretary of State. |
4. | If applicant is a partnership, list all general and limited partners:________________________ |
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5. | Operating location:______________________________________________________ |
| a. The operating location shall be identified by submitting a site plan, drawn to an acceptable engineering scale and containing: parcel identification (Tax Assessor’s Map and Lot); ownership; zoning classification; and identification of the exact location on the premises and a GIS map of the premises where vehicles are to be rented or leased. If applicant has entered into a lease for the property from which mopeds, tripeds, and scooters are to be rented, attach a copy of the lease agreement. (Note: If license is issued, it will be issued for this location only.) |
| b. The vehicle proficiency area shall be identified by submitting a site plan, drawn to an acceptable engineering scale and containing: parcel identification (Tax Assessor’s Map and Lot); ownership; zoning classification; and identification of the exact location on the premises and a GIS map of the premises where the applicant proposes to operate a vehicle proficiency area where renters practice using the vehicle before going onto state or Town roads. |
| c. The applicant's plan for the off-season storage of vehicles that complies with state law and Town ordinances. |
6. | Insurance coverage for operators of rented mopeds, tripeds, and scooters and insurance coverage for any liability of the applicant/lessor for personal injury and/or property damage by reason of the rental of the applicant's/lessor mopeds, tripeds, or scooters, not less than $10,000 coverage for property damage per accident, $25,000 for injury or death sustained by one person, and $50,000 for all personal injuries or deaths resulting from one accident: |
| Name of insurance carrier______________________________________ |
| Property damage_____________________________________________ |
| Personal damage_____________________________________________ |
7. | Describe type of (a) mopeds, (b) tripeds and (c) motor scooters applicant intends to rent: |
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8. | (a) Number of vehicles and registration numbers as issued by the State of Rhode Island and the Vehicle Identification Number as issued by the manufacturer of each vehicle applicant intends to rent:_______________ |
| (b) As to each such vehicle, a certificate by duly authorized state inspection facility indicating that any such vehicle passed an annual inspection, as governed by rules promulgated by the Rhode Island State Department of Transportation.__________________________________________________________ |
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9. | Does applicant or any officer, director, shareholder or partner thereof or any entity in which applicant is an ownership interest or if applicant is an individual, any member of applicant's immediate family have any other license to rent mopeds tripeds, or motor scooters in the Town of New Shoreham or have any interest, direct or indirect, in any other such license issued or applied for? |
| Yes_____________ If yes, give details of license:________________________________ |
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| No_____________ |
10. | If applicant is a corporation, do any shareholders own shares of, or have any direct or indirect interest in, an existing corporation licensee, or a corporation for which a license has been applied for? |
| Yes_____________ If yes, name existing license:__________________________________ |
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| No______________ |
11. | If applicant is a corporation, is any officer or director thereof, an officer or director of an existing licensee? |
| Yes_________ If yes, name existing license and office or directorship held.______________ |
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| No_____________ |
12. | Has applicant been convicted of any felony or misdemeanor within the past five years? |
| Yes_____________ If yes, specify: __________________________________________ |
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| No_____________ |
13. | Has applicant been found to have violated any motor vehicle law or code within the past five years? |
| Yes_____________ If yes, specify:__________ |
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| No_____________ |
14. | Has applicant been found to be in violation of any ordinances of New Shoreham within the past five years? |
| Yes_____________ If yes, specify:________________________________________ |
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| No______________ |
15. | Does applicant give the Town Council permission to contact state municipal authorities and applicant's insurance agent, broker, or carrier to obtain information relating to this application? Yes__________ No__________ |
16. | If applicant has been issued a license by the State of Rhode Island or the Town Council hereunder to rent motorized bicycles, motorized tricycles or motor scooters the previous year, attach a copy of applicant's financial statements. If applicant has been previously issued a license by the State of Rhode Island or by the Town Council hereunder, attach a copy of the license. If applicant has not previously been issued a license, attach a copy of applicant's pro forma financial statements. |
17. | Is this an ( ) original application? |
| ( ) renewal application? |