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«APPLICATION TO PURCHASE A NON-WHEELCHAIR STREET HAIL LIVERY PERMIT Please visit our website for more information at: or our office ...»

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APPLICATION TO PURCHASE A NON-WHEELCHAIR

STREET HAIL LIVERY PERMIT

Please visit our website for more information at: www.nyc.gov/tlc, or our office at 31-00 47th Avenue,

3rd Floor, Long Island City, NY 11101 or contact our Call Center at 718-391-5501.

YOU MUST SIGN THIS DOCUMENT AND SUBMIT YOUR APPLICATION!

Please read this document carefully as it contains important information regarding a change in the classification of the Non-Wheelchair Accessible SHL permit you are about to purchase. If, after reading the below, you still want to purchase the permit you must sign below and submit this document with your application on the date of your appointment.

IMPORTANT: All Non-Wheelchair Accessible Street Hail Livery Permits issued in the second issuance period, which begins in August of 2014, will be sold as “Convertible (Non-Wheelchair Accessible) SHL Permits” (Convertible SHL Permits). The TLC will be randomly selecting a minimum of 1,500 of the 4,800 Convertible SHL Permits issued for permanent conversion to a Wheelchair Accessible SHL (WAV SHL) Permit once the second issuance period ends. You must acknowledge your understanding of this below.

What happens If my Convertible Non-WAV SHL Permit is randomly selected?

If the Convertible SHL Permit you purchased is selected to be permanently converted to a Wheelchair Accessible SHL Permit (WAV SHL) your permit type will be permanently changed to a Wheelchair Accessible Permit in our systems and you will be required, at the designated time, to replace any Non-Wheelchair Accessible Vehicle you have affiliated to the permit with a wheelchair accessible vehicle. You will only be allowed to affiliate a Wheelchair Accessible Vehicle to the permit from that day forward. No other vehicle will be allowed.

How long will I have to convert my vehicle from the date of purchase?

You will not be required to convert to a Wheelchair Accessible Vehicle before the first renewal of your permit which is three (3) years from the date of purchase.

For information on the new changes to the the permit type or about grant funding, please visit our website at: www.nyc.gov/tlc/shl ***In order to process an application the signed affirmation below must be submitted with each application submitted to purchase a Convertible Non-Wheelchair Street Hail Livery Permit***

AFFIRMATION

I, ____________________________________, (business entity representative for the business entity purchasing the permit\sole (Print Name) proprietor\officer\principle) acknowledge my total and complete understanding that the non-wheelchair Street Hail Livery Permit being purchased today is a Convertible SHL Permit and that it may be selected by the Taxi and Limousine Commission (TLC) as one of the SHL Permits which can be permanently converted from a non-wheelchair accessible permit to a wheelchair accessible permit in accordance with the timetable that is set by the TLC. If my Convertible SHL Permit is selected by the TLC for conversion to a Wheelchair Accessible SHL Permit I affirm my total and complete understanding that I will be required to, by the date designated by the TLC, place a wheelchair accessible vehicle on my permit and that my permit will become, from that day forward, a wheelchair accessible SHL Permit and that no other vehicle other than a wheelchair accessible vehicle will be allowed to be affiliated\attached to this permit or hacked-up under this permit. With the submission of this document, my application and the payment of all fees associated with the purchase of the permit I accept these conditions regarding the convertible nature of the permit I am purchasing and agree to abide by and comply with any and all directives or notices issued by the TLC regarding the conversion of my permit from a non-wheelchair accessible permit to a wheelchair accessible permit.

–  –  –

Convertible Non-WAV SHL Permit – Important Notice/ Affirmation 6.13.16

STREET HAIL LIVERY PERMIT APPLICATION

REQUIREMENTS AND CHECKLIST

_______________________________________________________________________________

Please visit our website for more information at: www.nyc.gov/tlc, or our office at 31-00 47th Avenue, 3rd Floor, Long Island City, NY 11101 or contact our Call Center at 718-391-5501.

PURPOSE OF THIS FORM: This checklist is to be used in conjunction with the “Street Hail Livery Permit Application Form” to submit an application to the NYC Taxi and Limousine Commission to obtain a Street Hail Livery Permit.

*In order to attach a vehicle to this permit, once granted, you must have your SHL base schedule an appointment for you. If applicable, you may use your existing vehicle. On the day of your appointment, you’ll need to bring your appointment form, a completed “Vehicle Application Form” and all required documents.

HOW TO SUBMIT AN APPLICATION FOR A STREET HAIL PERMIT: Please visit our website at:

www.nyc.gov/tlcappointment to request an appointment to submit your “Street Hail Livery Permit Application Form.” All requirements listed below must be submitted on the day you are scheduled to bring your application.





NOTE: If the permit applicant/owner does not want to appear at the TLC in person, they may choose someone to come to the TLC for them by filling out the Street Hail Livery Permit power of Attorney which can be downloaded at www.nyc.gov/tlc/shl.

You must submit all items listed on this checklist with your application. If an item is missing, your application will NOT be accepted. Applicants are responsible for reviewing ALL requirements listed on this checklist. FEES ARE NOT REFUNDABLE.

Street Hail Livery Permit Application Form: must be completed and signed.

New Application Fee: Payable to the NYC Taxi and Limousine Commission (See method of payment below) The fee to purchase a Street Hail Livery Permit for year two (2) is $3,000.

Inspection Fee: Five Hundred and Forty Dollars ($540.00): This fee covers the six (6) DMV\TLC inspections required during the three (3) year term of the license. Inspection fees must be prepaid with each new and renewal application. Note: Paratransit Vehicles licensed as Accessible Street Hail Liveries will be subject only to a visual inspection to assure that they are accessible and that the accessibility features are operating in addition to a meter test.

Zero outstanding judgments: to the TLC, NYS DMV Traffic Violations Bureau (TVB), Department of Finance (DOF) Parking Violations and DOF Red Light Bureau (i.e., unpaid tickets) and Commercial Motor Vehicle Tax (CMVT).

Government Issued photo I.D. of applicant. For example, US passport.

Social Security No. / Proof of EIN: If a corporation or partnership, you must submit an IRS issued CP-575 Notice or a 145-C letter (provided as a replacement or verification letter to business). If a sole proprietor, you must submit proof of a valid social security number.

SHL Service Requirement – A Street Hail Livery License must be placed into service with a For-Hire Vehicle within:

· 90 days of issuance if the SHL is a Convertible Non-Wheelchair Accessible Permit · 180 days of issuance if the SHL is a Wheelchair Accessible Permit A permit holder can apply for one extension provided that they submit an application for consideration PRIOR to their in service requirement date (90 or 180 days from permit issuance). There will only be one (1) extension granted per permit to place a vehicle in service. If the extension is granted, based upon the application and documents submitted, it will be for a MAXIMUM of thirty (30) days only. No additional extensions will be granted.

***FEES can be paid by Money Orders, Certified Checks, Master Card, Visa, AMEX or Discover. Money Orders and Certified Checks are payable to: NYC Taxi & Limousine Commission. A Street Hail Livery Permit must be placed into service with a licensed TLC vehicle within (90) days of issuance. Exception: A Street Hail Livery Permit that is restricted to use with a Wheelchair accessible vehicle must be placed into service with a For-Hire Vehicle or a Paratransit Vehicle within (180) days of issuance. Note: A maximum of two (2) credit cards will be accepted to process a payment.

–  –  –

You must submit all items listed on this checklist with your application. If an item is missing, your application will NOT be accepted. Applicants are responsible for reviewing ALL requirements listed on this checklist. FEES ARE NOT REFUNDABLE.

–  –  –

The permit must be affiliated to an SHL Endorsed Base at the time a vehicle is being attached to a permit. This form does not have to be submitted with the “Street Hail Livery Permit Application” form. Please see page 5 for more information.

Original and copy of SHL permit Original and copy of proof of identification (DMV license, passport) If this is base transfer and not a first time affiliation, a $25.00 payment is required.

–  –  –

Wheelchair Accessible Grant Proposal: Grant funding for purchasing or upfitting a Wheelchair Accessible Vehicle is available from the City of New York. If you are interested in the grant funding please read and complete a Grant Application package.

Please visit our website at: www.nyc.gov/tlc/shl to download the required forms.

Post Licensure Requirement for Hack-Up of a Vehicle

Workers’ Compensation: A Valid Workers’ Compensation Insurance Policy or an Exemption Letter issued by the New York State Workers’ Compensation Board (WCB) with the Permit number listed, must be provided to the TLC in order to complete the Hack-Up process. You will not be issued a Hack-Up Certification Letter if you do not provide proof of coverage. The policy presented can contain no exclusions as to service type and must cover both street hails and dispatch service.

***FEES can be paid by Money Orders, Certified Checks, Master Card, Visa, AMEX or Discover. Money Orders and Certified Checks are payable to: NYC Taxi & Limousine Commission. A Street Hail Livery Permit must be placed into service with a licensed TLC vehicle within (90) days of issuance. Exception: A Street Hail Livery Permit that is restricted to use with a Wheelchair accessible vehicle must be placed into service with a For-Hire Vehicle or a Paratransit Vehicle within (180) days of issuance. Note: A maximum of two (2) credit cards will be accepted to process a payment.

–  –  –

Along with all required items listed on the Vehicle Application Checklist, businesses must also

include the following documents for your business type:

If the Applicant is a partnership, it must file with its application a certified copy of the partnership Partnerships certificate from the clerk of the county where the partnership’s principal place of business is located.

If the Applicant is a corporation, it must file with its application: A certified copy of its certificate of Corporations incorporation; a list of officers and shareholders; a certified copy of the minutes of the meeting at which the current officers were elected.

Limited If the Applicant is a limited liability company, it must file with its application: A copy of its articles of Liability organization; a copy of its operating agreement; a list of the members, with the percentages of the Companies Applicant owned by each. We cannot accept an election of officers form for an LLC as they do not (LLCs) have shares in an LLC only percentages are assigned.

Each of the above are also required to submit the photo identification and social security cards of each of its stock holders or members or managing members, whichever is applicable. They also need to submit the IRS issued CP-575 Notice or 147-C letter for the business.

–  –  –

Please visit our website for more information at: www.nyc.gov/tlc, or our office at 31-00 47th Avenue, 3rd Floor, Long Island City, NY 11101 or contact our Call Center at 718-391-5501.

–  –  –

I. BACKGROUND INFORMATION ON APPLICANT (All fields in this section must be filled-out completely for your application to be processed)

–  –  –

If you have multiple officers, please photocopy this page and have each officer that has 10% or more shares fill this form out in full.

All questionnaires must be COMPLETED & SUBMITTED with your application.

Character/History of Principals

Have you ever:

–  –  –

If you answered “YES” to any of the preceding questions you must provide a signed statement (below or on a separate document) giving pertinent information and documentation including but not limited to names, dates, license numbers, certificate of deposition etc.

–  –  –

In order to process an application a signed affirmation must be submitted for each application.

Signatures must be original and signed by hand. No copied or stamped signatures.

–  –  –

I understand that:



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