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CC Resolution No. 1803 63 RESOLUTION NO. 1803 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF BAYTOWN, TEXAS, ADOPTING GUIDELINES FOR THE SENIOR/DISABLED CITIZEN TRANSPORTATION PROGRAM; AND PROVIDING FOR THE EFFECTIVE DATE THEREOF. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF BAYTOWN, TEXAS: Section 1: That the City Council of the City of Baytown, Texas, hereby adopts its Senior/Disabled Citizen Transportation Program Guidelines. The guidelines are attached hereto as Exhibit "A" and incorporated herein for all intents and purposes. Section 2: This resolution shall take effect immediately from and after its passage by the City Council of the City of Baytown. INTRODUCED, READ and PASSED, by the affirmative vote of the City Council of the City of Baytown this the 13th day of July, 2006. SAM , Mayor Pro Tem jA3ES LOO Y, City Clerk APPROVED AS�TO FROM: ACIO RAMIREZ, 0., City Attorney R:UeaneneVy Documents\Council\05-06Vuly Ist\AdoptTransportationProgramGuidelines.doc CITY OF BAYTOWN SENIOR/DISABLED CITIZEN TRANSPORTATION SERVICE PURPOSE The City of Baytown Senior/Disabled Citizen Transportation Program (the "Program") is sponsored by the City of Baytown Community Development Block Grant Program in collaboration with the Harris County Coordinated Transportation Program ("HCCTP"), a description of which is attached hereto as Exhibit A. The goal of the Program is to provide eligible senior and disabled citizens non-emergency transportation services within the city limits of Baytown and to and from Houston for medical appointments. PROGRAM DESCRIPTION The Program will be administered on a six-month basis, each such period shall be referred to as the "Program Period". Participants of this Program are required to provide proof of eligibility. Participants must apply at the Community Development Office and, if eligible, will be issued a Customer ID Number and an information ride card on each HCCTP transit provider ("Provider") to call for service. A sample information ride card is attached as Exhibit B. Each Provider will be given an allotment of rides at the beginning of the Program Period. If the Provider uses all of the allotted number of rides, the Community Development Staff, in its sole discretion, may authorize additional rides for that month. If the Provider does not use the allotted number of rides within the month for which they are given, the unused rides will roll- over from month to month. On the tenth day of each month, the Transportation Provider must provide documentation of each ride provided under the Program during the previous month. Rides afford each participant non-emergency transit service with a Provider. When a participant needs transit service, he or she must contact a non-metered Provider that has contracted with the HCCTP to schedule his or her ride. The Ride Coupon has a face value of$5.00 each. The number of coupons required for a single trip is based on mileage. For rides originating within I — 3 miles from the destination, the Provider will charge the City one coupon for a one-way trip. For rides originating within 4 — 5 miles from the destination, the Provider will charge the City two coupons. Cash cannot be used. If a participant chooses to use a meter fare Provider, the participant may purchase ride coupons any time at a reduced cost from the HCCTP's main office located at 2700 Southwest Freeway, Houston Texas 77098. The participant will present his or her Customer ID Number and photo identification to the Provider. The Provider will transport the participant to his or her destination within the city limits of Baytown or to medical appointments in Houston. A ride detail log will be completed by the Provider and signed, if correct, by the participant. The Provider will then submit the Ride EXN�IT A 1 detail log to Harris County for verification and payment in accordance with the terms and conditions of the HCCTP. The City of Baytown will contract with Harris County to provide Ride Coupons. Harris County will contract annually with Providers for the provision of transportation services pursuant to the HCCTP guidelines, which are attached hereto as Exhibit C. Participants must comply with the rules and guidelines established by Harris County for the HCCTP. ELIGIBILITY To be eligible for participation in the Program, an applicant must: 1. be a resident of the City of Baytown and provide proof thereof, which may include one or more of the following: a. utility bills (water, electricity, gas, or phone) for at least three (3)months indicating that service is provided in the applicant's name; b. rent receipt indicating that applicant resides at the premises for which rent is being paid; and/or C. deed or lease indicating that the applicant owns/resides at the premises; 2. be either: a. 65 years of age or older and provide proof thereof, which may include one or more of the following: 1. State-issued photo Identification Card and/or 2. State-issued Drivers' License; or b. have a disability as certified by the applicant's doctor on the certification form, which is attached hereto; 3. file a completed application, a sample of which is attached hereto as Exhibit D, and submit such completed application to the City of Baytown's Community Development Office located at 2401 Market Street, Baytown, Texas; and 4. satisfy the following income eligibility requirements: a. Participants' annual gross income must not exceed the maximum low- income limits, which will be recalculated each year based on HUD's guidelines and the median income of the Houston Primary Metropolitan Statistical Area. b. To prove the applicant meets the above-referenced income eligibility requirements, the applicant must submit with his/her application all of the following applicable information: 1. Social Security Award Letter; 2. Retirement Verification; 3. Veteran's Administration Award Letter; 2 4. Food Stamp Award Letter; 5. Bank Statements for the past three (3) months; 6. Investment Interest; 7. Verification of Self-Employment; 8. Welfare Verification; 9. Supplemental Social Security Income Award Letter; and 10. Proof of any other source of income. SERVICE AVAILABILITY The level of service available is determined by advanced reservations for ride sharing with other passengers. The Providers have service Monday through Friday 6 a.m. — 7 p.m. The HCCTP Transportation Providers List (Exhibit E) has a list of non-metered Providers currently contracted with HCCTP and their hours of operation. Advanced reservations— ride sharing with a group of passengers (non-metered providers) The Providers do not accept cash. Reservations may be made a minimum of one day to four days ahead of the requested trip date. Service is available Monday through Friday but cancellation requests are accepted everyday. Reservations are taken as follows: • For Monday trips, reservation may be taken Thursday through Friday of the previous week by 2:00 P.M. on Friday. • For Tuesday trips, reservation may be taken Friday of the previous week through Monday of the week in which the ride is needed by 2:00 P.M. on Monday. • For Wednesday trips, reservation may be taken Saturday of the previous week through Tuesday of the week in which the ride is needed by 2:00 P.M. on Tuesday. • For Thursday trips, reservation may be taken Monday through Wednesday of the week in which the ride is needed by 2:00 P.M. on Wednesday. • For Friday trips, reservation may be taken Tuesday through Thursday of the week in which the ride is needed by 2:00 P.M. on Thursday. Trip Days Reservation Taken Monday Friday by 2:00 P.M. Tuesday Monday by 2:00 P.M. Wednesday Tuesday by 2:00 P.M. Thursday Wednesday by 2:00 P.M. Participants may not make reservations with more than one Provider for any given trip. Overbooking constitutes abusing the program. The City of Baytown Senior/Disabled Transportation Program and the HCCTP reserve the right to remove participants from the program who for any reason (s) are found to be abusing the Program, not iust by overbooking but in any manner. 3 A participant may make no more than two (2) cancellations in any 30-day period. Upon the third (3Td) cancellation in a 30-day period, a one-month suspension will be imposed on the participant. GENERAL PROGRAM RULES AND INSTRUCTIONS I. Once participants have completed the application process at the Community Development Office and a member of the Community Development Staff deemed a person eligible, they will be issued a Customer ID number and an information Card with details about the Providers. In order to obtain transportation services, a participant must call a Provider on the Transportation Providers List (Exhibit E). The Providers List and telephone numbers of participating Providers shall be updated as necessary. 2. Under the Program, a participating Provider shall pick up a participant at the origination point designated by the participant within the city limits of Baytown and take the participant to the destination point designated by the participant within the city limits of Baytown or in Houston for medical appointments; provided, however, that neither the origination or destination point shall be an establishment primarily serving or selling alcoholic beverages (bars/liquor stores). The Providers have been notified of this restriction and shall not accept the responsibility to transport a participant to such an establishment under the above- stated circumstances. The City will deny payment for such rides. 3. When the Provider arrives to pick up a participant, the participant must present the Customer ID card and/or photo identification to the Provider. 4. In order for the Ride(s) to be valid, the riders' log must be signed by the participant. 5. The participant must be present and personally utilize the service for the Ride to be accepted by the Provider. Another person(s) may accompany the participant at no additional charge; provided, that the other person(s) and the participant have common origination and destination points. The Rides cannot be used by any other person(s) even if such other person(s) qualifies for the Program. 6. If Ride Coupons are needed for the meter providers, the participant may contact the Harris County Coordinated Transportation Program to PURCHASE the Ride Coupons. 7. The second leg of a round trip will require the same number of Ride Coupons as used on the first leg of the trip if the pick-up and/or drop-off locations are the same. 4 8. No person may smoke in a Provider vehicle while the same is occupied by a Program participant. Neither the participant nor the Provider can waive this requirement. 9. Participants must be courteous to the reservation agent as well as to the Providers. Obscene or threatening language used with at a reservation agent or Provider will not be tolerated and may result in the participant's removal from the Program. 10. Participants must report a change of address within ten (10) calendar days of his/her new address to maintain eligibility. Address changes should be sent in writin to the Community Development Department, 2401 Market Street, Baytown Texas 77520. It. Participants in the Program shall comply with the rules of the Program. Upon the determination of the Community Development Planning Manager that a violation of any provision of the guidelines has occurred, the participant may be suspended for one month from the Program. Neither the Provider nor any of its employees or subcontractors is authorized to make a determination regarding a participant's noncompliance with the terms and conditions of these guidelines, and therefore, may not refuse service on this basis. However, the Provider or HCCTP may submit complaints regarding participant's behavior to the Community Development Planning Manager for investigation. If the Community Development Planning Manager determines that a participant shall be removed from the Program, the participant shall be notified of such decision in writing, which will be mailed to the address on file at the Community Development Office. Any person wishing to appeal a decision of the Community Development Planning Manager, on the grounds that the decision misconstrues or wrongly interprets these guidelines may, within thirty (30) days after the decision, appeal the decision to the City Manager or his or her designee, provided that the participant gives notice of appeal in writing to the City Clerk no less than ten (10) days following the written notice of the decision which the participant is appealing. The decision of the City Manager or his or her designee shall be final and binding on the participant, the Provider and the City of Baytown. If the decision of the Community Development Planning Manager is not properly appealed, the decision of the Community Development Planning Manager shall be final and binding on the same parties. 13. Complaints regarding the Program should be made in writing and sent to the following address: The City of Baytown Senior/Disabled Citizen Transportation Program, Community Development Department, 2401 Market Street, Baytown, Texas 77520. Telephone: 281-420-7158. R:\Karen\Files\Community Development\Transponation Program\TaxiGuidelinesforHCCCTPwithChanges3-1-06_.doc 5 %%CCTp HARRIS COUNTY COORDINATED TRANSPORTATION PROGRAM Harris County Coordinated Transportation Program (HCCTP) Who Can Use Service • Elderly(over 60),disabled, and low-income residents of Harris County that are unable to access alternate transportation and are not served by MetroLift or Medicaid Medical Transportation PICTURE ID MUST BE PRESENTED UPON BOARDING VEHICLES Description of Service • HCCTP is a subsidized transportation program that utilizes ride tickets for payment of transportation services. The ticket value is$5.00 and may be purchased in a book of ten (10) for $25.00. For each book of ten(10)tickets, you receive$50.00 in transportation services. Customers may select from two modes of transportation: shared ride service or taxi cabs. The program has four(4)transportation providers customers may call for service: three(3) shared ride providers and one(1) taxi company. The number of tickets required for a one-way trip is based on either mileage for a shared ride trip,or the meter fare box if using a taxi. The maximum number of tickets that can be used for a one-way Taxi Trip is eight(8). Shared Ride Pay Scale Miles Customer Pay Amount #of Tickets 0-3 miles $2.50 1 Ticket 4-5 miles $5.00 2 Tickets 6-10 miles $7.50 3 Tickets 11-15 miles $10.00 4 Tickets 16-19 miles $12.50 5 Tickets 20 miles or $15.00 6 Tickets over in Harris County Taxi Rates • Taxi Trip rates are based on the Rate of the Meter Fare Box—call the Program's Taxi Company Providers for an estimated trip rate to specific destinations. The maximum number of tickets that can be used per one-way Taxi Trip is eight(8). Reservation Requirements • Shared ride services require a minimum of 1 day advance reservation(24 hours)—Call before 2:00 PM. • Taxi cabs require a minimum of 90 minutes advance reservation. EXHIBIT A 7/3/2006 Passenger Quick Ref Provider List(revision III)_COBT HCCTP Harris County Coordinated (713)313-1765 Transportation Program N 2 031767 EXPIRATIONDATE:DEC.31,2006(NO REFUNDS OR EXCHANGES)NON-TRANSFERABLE City of Baytown TICKET VALUE.$5.00 Agency Code:COBT HCCTP—Harris County Coordinated Transportation Program(713)313.1765 Shared Ride Providers Taxi Providers American Red Cross Pasadena Taxi Company (713)313-1631 (713)477-6000 Wheelchair Accessibility Provided Wheelchair Accessibility Provided Hams County Social Services (713)696-1990 Wheelchair Accessibility Provided Reliant Transit Services (713)665-3535 Wheelchair Transfer Ability MW B HARRIS COUNTY COORDINATED TRANSPORTATION PROGRAM 2700 SOUTHWEST FRWY, HOUSTON, TX 77098 (713) 313-1765 ��� 04*4 PASSENGER USER GUIDE (Please read this guide before making your first reservation!) What is HCCTP? The Harris County Coordinated Transportation Program (HCCTP) provides transportation services for people who are disabled, and people who are elderly that reside in Harris County outside of the Metro Service Area, and are unable to access alternate transportation. Transportation providers are contracted by Harris County (HCCTP) to provide transportation service within Harris County. Levels of Service There are two (2) levels of service available: (1) Advanced reservations for ride sharing with other passengers. (2) Same day service for rides dispatched on the same day as the request. (taxicabs) Registration To use the HCCTP service, you must be registered as an eligible customer either directly with the Program, or with a sponsor agency and have an assigned Customer ID number. If you are registered with an agency, please contact them for specific information about registration requirements. Clients that are not registered with a sponsoring agency may contact the Program and fill out an eligibility form to participate in the program. Once you are approved and registered, you are eligible to receive discount travel coupons that may be used with any of the designated transportation companies. Service Availability Service by taxicab is available 24 hours per days, 7 days per week. Other transportation contractors provide service by advanced reservations, Monday through Friday 6 a.m. — 7 p.m. (See the Transportation Providers List for specific hours of operations) Coupon Distribution Coupons are used for trip payments and are distributed by your sponsoring agency, or purchased at $1.00 each by the passenger. The face value of the coupon is $5.00 each. Please contact your sponsoring agency for detailed information on coupon distribution and policies on coupon use. (Passengers may use a combination of cash and coupons when using taxi cabs) Subsidized trips require 20% co-pay after eligibility is determined ($1.00 per coupon) PASSENGER USER GUIDE(2) am C Service Guidelines Advance reservations - ride sharing with a group of passengers (Non-metered Providers) Reservations may be made a minimum of one day and up to four days ahead of the requested trip date. Call a transportation provider who offers service in your area. Service is Monday through Friday but cancellation requests are accepted every day. Reservations are taken as follows: • For Monday trips, reservations may be received Thursday through Friday by 2 p.m. • For Tuesday trips, reservations may be received Friday through Monday • For Wednesday trips, reservations may be received Saturday through Tuesday • For Thursday trips, reservations may be received Monday through Wednesday • For Friday trips, reservations may be received Tuesday through Thursday • You may have up to 2 cancellations in any 30 day period. Upon the third (3rd) cancellation, in a 30 day period, a 30-day suspension from use of the program will follow. HCCTP and your sponsoring agency reserve the right to remove customers from service who are found to be abusing the service by overbooking reservations. Same-day dispatched service reservations by taxicabs • Reservations may be made a minimum of 90 minutes in advance of the requested trip. • Advance reservations will be accepted no earlier than 6:00 p.m. on the day before travel. • For advance-scheduled trips, cancellations must be made at least 4 hours ahead of the requested trip time, or as soon as it is known that the trip will not be taken, whichever comes first. • For same-day trips, cancellations will be accepted up to one hour before the requested trip time. After that, cancellations will be regarded the same as no- shows. You want to avoid no-shows! (Please refer to "No-shows" in the "Terms-You Need To Know" Section of this guide) Considerations Before Making Your Reservation How many people will be traveling with you? • If you have more than one person traveling with you, then you may consider selecting a taxicab for your trip. Taxicabs will allow up to 4 passengers (including yourself) to ride for the price of one passenger, providing it is the same pick-up and same destination address. How soon do you need service? • If you need same day service—Call a taxicab • If your trip can be scheduled in advance - Call a non-metered provider in your service area PASSENGER USER GUIDE (2) What type of passenger service do you want? • If you can ride share with a group of people—Call a non-metered provider • If you want single passenger service—Call a taxicab How much do you want to spend? • Fares are quoted for one-way trips. If you need a return trip, the amount is double that amount. For example, if you are quoted a fare of$20.00, and you need a return trip, then your total cost would be $40.00 for the round-trip. • You may want to evaluate the level of service you select based on your needs and the cost involved. • Taxi cabs are the only providers that accept cash. All other providers must be paid with HCCTP coupons —value of$5.00 each. Taxi cabs will also accept a combination of cash and coupons. No cash will be returned to you if paying with all coupons and the fare amount is under the total value of the coupons. Making Your Reservation 1. Call a provider based on your travel needs 1. Identify yourself as a HCCTP customer and give your name and Customer ID number to the reservations agent 2. Tell the reservation agent your requested pick-up time and address 3. Tell the reservation agent your drop-off location & appointment time 4. Tell the reservation agent when you would like to return (if a return trip is needed) 5. If you require a companion, — please advise the reservation agent 6. If you require wheel chair accessibility please advise the reservation agent 7. The reservation agent will give you a pick-up time, a fare amount, and a confirmation number-please write this number on your coupon (s)that you will use to pay for your trip. (Please be aware of your sponsor agency's criteria for use of coupons.) How to change the time of a scheduled ride • For advance scheduled service with a non-metered provider, reservation changes should be made at least 4 hours ahead of your original travel time or as soon as you know you need to change your schedule. • If your ride is an advance reservation with a non-metered provider, and you change your reservation on the same day that you are traveling,please be aware that the provider may not be able to accommodate your request, due to space availability. • For taxicab provided service, please notify them as soon as you know you need to change your pick-up time. How to cancel a scheduled trip • Cancellation calls can be made to providers 24 hours a day, 7 days per week. (See Service Guidelines for cancellation restrictions) • Provide the reservation agent with your confirmation number given to you when you originally scheduled your reservation. PASSENGER USER GUIDE(2) When Your Ride Arrives! • Bring your coupon(s) • Present your coupon(s) to the driver at the beginning of your trip (or coupon/cash combination for taxi rides). The driver will complete the information on the coupon(s) and request your signature at the end of the trip. Drivers do not expect any tips. Repeat the same procedures for your return trip • If the driver arrives and you do not have coupons for payment, you will be charged with a No Show. (Please see"Terms You Need To Know" of this guide) Frequently Asked Ouestions • May I travel with a companion? You may travel with one companion when selecting a non-metered transportation provider. A companion is an adult 18 years or older. If you will be traveling with a companion, please advise the Transportation provider of this need when you make your reservation. Taxi service allow four passengers (including you) to ride for the price of one passenger, providing it is the same pick-up address and same destination. • Is Accessible service available? Accessible vehicles are available by some of the transportation providers, (please see the Provider List). Accessible vehicles, each equipped with a lift or a ramp, are available for people who need a lift or ramp to board a vehicle. Please let the reservations agent know that you need accessible service when you reserve your trip. Accessible service is available at the same price and with the same service standards as non-accessible service. • May I use my Wheelchair or scooter? Wheelchairs that meet the ADA standard are permitted onboard the vehicle. Please inform the reservation agent of your wheelchair or scooter use so an accessible vehicle may be sent to pick you up. The maximum lift capacity is 600 pounds, including the person in the wheelchair, and the maximum dimensions are 48 inches long and 30 inches wide. • Is Passenger assistance available? Drivers may assist you into and out of the vehicle, and assist you with some small packages weighing less than 20 pounds. A reasonable level of assistance will be provided to each passenger. • Are Portable Oxygen Tanks permitted? Portable oxygen tanks are permitted onboard. You must have full control of the tank, or be traveling with someone who can assist you. PASSENGER USER GUIDE (2) • Are Service Animals permitted? Service animals such as a seeing-eye dog or a hearing dog that assist a customer with a major life activity are permitted on board. Please inform the reservation agent that you will be using a service animal when you make your reservation. • Are Pets permitted? Pets are not permitted to be transported. • Are Safety Belts required? For your safety, you are required to wear a seatbelt while onboard a Para Transportation vehicle. • Is service affected during inclement weather? During inclement weather, there may be times when the HCCTP program is not operating on a normal schedule. Every effort will be made to provide minimal service interruption for customers needing a life sustaining service such as dialysis. Contact the selected transportation service provider for current information on service affecting weather conditions. Emergency Procedures If you have an emergency not related to transportation - Dial 9-1-1 • In the event of an accident or emergency while onboard the vehicle, please remain calm and follow the instructions of the driver. • If you should become ill, or notice another passenger who may be ill, please immediately inform the driver. • It is your responsibility to have access to your destination and/or home, or have someone to meet you when you are dropped-off. • There are instances when a trip may take longer than expected. Bring any medication you need. If you have a medical need, you may want to carry a small snack. Rider Courtesy We ask that riders observe the following Rules of Conduct: • No smoking in the vehicles • No eating or drinking on-board (unless required for health reasons) PASSENGER USER GUIDE (2) • No riding with containers of alcohol or with illegal drugs • No abusive, threatening, or obscene language or actions • No deliberate fare evasion • No physical abuse of another customer or of the driver • No petting of guide dogs or service animals without the permission of the owner • No playing of radios, cassette tapes, compact disks (without headphones), or other noisy equipment while on-board • No operating or tampering with any vehicle equipment while on-board Causes for Suspension and or Removal from Program • Passengers engaging in physical abuse or cause physical injury to another passenger or driver, or who engage in other illegal activities may be subject to immediate and permanent removal from service. • Passengers engaging in activity which seriously disrupts operations may also be subject to a suspension of service. • Deliberately evading fare payment. • Any passenger who is suspended from service will be notified in writing and will be given an opportunity to appeal the suspension. • A passenger may be suspended from using the service for no-show and cancellation offenses as determined by your sponsoring agency or HCCTP. • Providers will be immediately alerted of all customer suspensions. Appeals Process • Customers will be notified by telephone initially, but will also receive written notice of any suspensions and removals from the program by the sponsoring agency or the HCCTP Program. • Any time a customer is removed or suspended from service, the customer has the opportunity to appeal the decision. All appeals must be in writing and submitted to the Harris County Coordinated Transportation Program office at: HCCTP 2700 Southwest Freeway Houston, Texas 77098 (713) 313-1765 • An independent panel will review your appeal within 30 days of receipt. PASSENGER USER GUIDE(2) • You will continue to receive service until the review panel has made a determination. • You will be notified in writing of the appeal decision. Suggestions, Comments and Complaints If you have questions or comments about a particular trip, please call the transportation provider. If you would like to provide a suggestion, comment or complaint about the HCCTP program, please call (713) 313-1765. All formal complaints should be provided in writing to: HCCTP 2700 Southwest Freeway Houston, Texas 77098 (713) 313-1765 All complaints will be acknowledged within a maximum of 3 business days in receipt of the complaint. Terms You Need To Know! Pick-up Window Pick-up window is the timeframe when your ride should arrive and be considered on- time. This designated time frame is 45 minutes - No earlier than 15 minutes prior to, and no later than 30 minutes after the scheduled (and agreed-on) pick-up time. Drivers are only required to wait 5 minutes after arrival of the designated pick-up window. No-shows If you fail to take a scheduled ride when the vehicle arrives within the pick-up window, it is considered a no-show. You may have up to 2 verified no-shows in any 30 day period. You are also charged a no-show if the provider arrives within the pick-up window and you cannot present coupons for trip payment. A no-show is also charged to you if the cancellation policy timeframes are not adhered to when using taxi service. Upon the third no-show in a 30-day period, a 30-day suspension from use of the Program will follow. For all no-shows, an attempt to contact you will be made by the transportation provider's dispatcher prior to the driver leaving the pick-up address. HCCTP and your sponsor reserve the right to remove customers from service who are found to be abusing the service by not taking the reserved trips. Please contact your sponsor agency for specific policies. Late trips Every effort will be made by the Transportation provider to provide the trip within the pick-up window. If a provider fails to pick you up within the pick-up window, you should contact the provider and make sure they are aware that you have not been picked up. Every effort will be made to provide you with a back-up ride. PASSENGER USER GUIDE (2) On-board travel time Under normal operating conditions, you should not be onboard the vehicle for more than 90 minutes. (For service provided by non-metered Providers) Taxi cabs provide direct service to your destination. Overage (Applies only when using a taxicab) The value of HCCTP coupons are $5.00 each. When using coupons to pay for a trip, and the fare amount is less than the value of the coupons used, the difference is considered overage. For example, if the fare is $22.00, and you use 5 coupons for a value of$25.00, the difference is $3.00. Customers will not be given any change back for the difference. In these cases the rider may want to pay the $2.00 and use the $5.00 coupon for another trip. Advanced Reservation Non-metered providers require advance notice to reserve a ride. Non-metered providers also use ride sharing with other passengers. (See service guidelines) PASSENGER USER GUIDE(2) SENIOR/DISABLED CITIZENS TAXICAB PROGRAM APPLICATION Applicant: First Name Last Name M.I. Social Security No. Date of Birth / / Race/Ethnicity— Home Phone (_) Work Phone Sex Check One: Single Married Divorced Widowed Address of Applicant: (All applicants must reside within the Baytown city limits to be eligible) Baytown, TX Number Street Apartment Zip Code Mailing Address: (If different from above) umber Street ApartmentC'i yam — St. Zip Name and Phone Number of Relative, Friend, or Neighbor who can usually contact you: Name Relation Home Phone Work Phone Income Information: Full disclosure of all income and assets must be made. Failure to disclose any income or assets is a criminal offense under Section 1001 of Title 18 of the U.S. Code. All income and assets will require verification from the providing sources before eligibility will be granted. Income includes all money flowing into the household, regardless of age of recipient. Such things as self-employment wages, AFDC, alimony, Social Security Benefits, Pensions, Child Support, regular gifts from friends or family, money earned from providing services, and interest income from bank accounts or investments must be disclosed. List yourself first. Household Member Source of Income Monthly Amount Receive Total Monthly Income Total Yearly Income OW D The above-named applicant has examined the eligibility requirements of the City of Baytown Senior/Disabled Citizen Taxicab Program and has submitted this application for participation in such program after certifying that all of the information so submitted is true and correct. It is expressly understood and agreed that should it be determined at any time by the City of Baytown, its officers, agents and/or employees that this application contains incorrect or incomplete information, the above-named individual shall be disqualified from participation in the Program and shall be required to repay the City of Baytown all expenses incurred as a result of such individual's participation. Furthermore, by submitting this application, the applicant hereby agrees to abide by all of the terms and conditions contained in the City of Baytown Senior/Disable Citizen Taxicab Program Guidelines and all amendments thereto. Failure to do so may, at the sole discretion of the City of Baytown, disqualify the applicant from further participation in the Program. Certification: The section below is to be signed by the applicant. A witness is needed for any signature made by mark. I certify this application has been completed to the best of my knowledge with complete and accurate information. I understand any false statements or omissions of facts relevant to my eligibility for assistance will be considered fraud, and that I may be prosecuted under applicable U.S. Codes for this fraud. Furthermore, I understand that assistance granted to my household based on fraudulent information must be reimbursed in whole to the City of Baytown. Applicant Date Witness (if signed by mark) The Community Development Office is wheelchair-accessible. Handicap parking spaces are available. For office use only: Full-Fare Half-Fare Card No. Issued Approved By Date Issued TRANSPORTATION PROVIDERS LIST AMERICAN RED CROSS: SHARED TRANSPORTATION -24 Hours ADVANCE RESERVATION REQUIRED TELEPHONE: (713) 313-1631 HOURS OF OPERATION: MONDAY — FRIDAY 6 A.M. — 7 P. M WHEELCHAIR ACCESSIBILITY PROVIDED HARRIS COUNTY SOCIAL SERVICES: SHARED TRANSPORTATION -24 Hours ADVANCE RESERVATION REQUIRED TELEPHONE: (713) 696-1990 HOURS OF OPERATION: MONDAY — FRIDAY 6 A.M. — 7 P.M. WHEELCHAIR ACCESSIBILITY PROVIDED RELIANT TRANSIT SERVICES: SHARED TRANSPORTATION-24 Hours ADVANCE RESERVATION REQUIRED TELEPHONE: (713) 665-3535 HOURS OF OPERATION: MONDAY — FRIDAY 7 A.M. — 6 P.M. WHEELCHAIR TRANSFER PROVIDED EMW E