1.The name, residence and business addresses of the applicant.

2.Social Security numbers, driver’s license numbers, and dates of birth for all persons named in the application. If the applicant is a partnership or corporation, then the information shall be provided for each partner or corporate officer.

3.Fictitious name under which the business is proposed to operate.

4.Whether any license, permit, or certificate sought by the applicant has been denied, revoked, or suspended by any public agency, explaining in full the circumstances of any denial, revocation, or suspension.

5.The number and type of vehicles proposed to be operated in the business, including year, make, model, license number, VIN, and company assigned taxicab number.

6.The color, name, monogram of insignia to appear on the vehicles.

7.A complete schedule of fares or rates to be charged and services to be operated, demonstrating compliance with existing fares and rates as established by the Regional Taxi Authority.

8.The location where the business will be operated, including dispatch facilities, storage facilities, repair and maintenance facilities, and fuel dispensing operations.

9.Copies of required insurance policies or, if not yet issued, a written statement from an insurer that such policies will be issued if the application is granted.

10.A statement as to whether any applicant, partner, or corporate officer, has been convicted of any misdemeanor or crime, or violation of any municipal ordinance other than minor parking and traffic offenses, the nature of the offense and the punishment or penalty assessed.

11.The facts upon which the applicant believes tend to prove that public convenience and necessity require the granting of a permit.

12.Such other information as the Regional Taxi Authority may deem necessary for promotion of the public health, safety, and welfare.