Village of Philo



GOLF CART OWNER PERMIT APPLICATIONVILLAGE OF PHILO, ILLINOISGolf cart owner’s name(s): _______________________________________________________________Owner’s Physical Address: _______________________________________________________________City/Town: _____________________________ State: ___________________ Zip: _________________Owner’s Mailing Address: (if different from Physical address): N/A Address: ______________________________________________________________________City/Town: _______________________ State: ___________________ Zip: _________________Contact Phone Number: ______________________ Alternate Phone Number: _____________________Owner’s Driver License Number: ____________________________________ State issued: ___________Make/Model of golf cart: ________________________________________________________________Year: ___________________________________ Color: ________________________________________Serial Number of golf cart: _______________________________________________________________Registration number (assigned by Village): __________________________________________________I have received, read and understand Ordinance #2020-635 amending the Village ordinance 2009-554 authorizing the operation of golf carts on the Village of Philo public streets. I have paid the registration fee for the above cart and agree to additional assessments as may be required in support of this ordinance. I acknowledge that I will assume all liability, and am fully responsible for the operation of the above cart on the streets and roads in the Village of Philo. I also acknowledge that the Village of Philo, in providing this privilege is in no way endorsing the operation of this golf cart on the streets and roads and does not and will not assume any liability in the operation of the cart. I agree to indemnify and hold harmless the Village of Philo for any and all liability arising from the use of this golf cart. I also understand that the Village of Philo and/or Board of Trustees of the Village of Philo’s interpretation of all the rules and regulations are final. I will insure that any assigned proof of compliance will remain attached to the rear of the cart at all times. I furthermore insure that I will obey all the rules/regulations set forth by the Village of Philo concerning the operation of a cart within the Village limits.___________________________________________ ________________________________Owner’s SignatureDate………………………………………………………………………………………………………………………………………………………………….For Village Use onlyApproved by: _____ Village President ____ Authorized Village Official (________________________)Golf Cart Inspection Check ListRegistrant/Owner Name: ________________________Signed waiverRegistrant/Owner is over the age of 16Has valid driver’s licenseHas proof of liability insuranceHornBrakesBrake lights are visible from 100 ftHeadlights are visible from 500 ftTurn signalsSteering apparatusTiresRearview mirrorSlow moving vehicle emblem attachedRed reflectors on front & backInspected by: __________________ Date: _____________Permit #: __________ ................
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