Loading...
HomeMy WebLinkAbout15-015CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 19) MY) 7 FAX 1. Name (REQUIRED) Authorization Number. 1,5-16 (Office Use Only) APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Failure to complete the "required" information will result in denial of the application 2. Mailing Address (REQUIRED) _ 3. Contact Information (REQUIRED) 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When N d 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the rwne(s= DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I h t t aye i¢sud to me by the Iowa Department of Transportation a valid Chauffeurs license number C C , _. I understand that if I falsely answer any questions in this application, that this may ay b denied. I iderstand that if I falsely answer any of the questions in this application, that this application will be denied. I agree that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, and I further agree that, if a license is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in fircn6 of a Notary Public) ��' """ /� I( , Signature of Applicant 16PA/G:1n °��/v1 StA Date ©2O S YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. x**#***x***x**kkk#t*tt*x****xx*R#tit*****krtx**#*ti*tk2**x***frkktkkth*x**x**xt**kt#t*t*x***iNR*x*tktttk*tk**x*****kkxtttt**t***#x**Q*kktt#**t*Rk STATE OF IOWA ) COUNTYOFJOHNSON ) bscribed and sworn to before me by �`2JGL� % �� I t 6--l-) On this 2—© — day of 2D) 5 f rte. �ic LgsyL KELLIE K. TUTTLE ig /'. F •� r2z1s1s otary Public in and for the State of Iowa o• Nay Cpmrll�ssroy Expires I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Chief or designee 141 15 Date YOU Ak4OT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. I / Sig'natutwof City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5'/:" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update ClerioTAXIDRr4BADGEAPPLM014amwn w DOC 09/2014 ian. 9. 2015 10:24AM Div of Criminal Investigation No -7666 P. 1/7 Jan. 8, 2015 11:5/AM City Clerk — City of Iowa City No. 5524 P. 2 Tot Iowa btvlalell of Criminal Investigation Support Operations Bureau,ls'Floor 2,15 P. 7" street Deslblohles,Iowa 50519 (SM 726.6066 (615)72,S•6090 Fax Iam reauestlner an Iowa Criminal HisturvRecord Check on: DCI Account Number: Lio(� p'! — otapplica le) Fromt Cityofl_owaCldy Cityclerk's Office 410 B. Washington Street �^ c Iowa City, U 52240 ra Phone: 919456~8041 Falc 319-36644517 LRO Naive menders Mrst Name (manlbisay) Middle Name (recommutd A"-Wsw► '�lVao r�,C_ I a C Date of Birth (m-nd*toW Gender imoudaloy) Social SecurityNumber c ed/command l I Mile ®Female Waiver Informadon, Without a signed waiver from the subject of the regaeat; a complete criminal history record may not he releasable, per Cade, of Iowan Chapter 691.2. For wm late criminal history record information, as allowed by lows always obtain a waiver al atura*omtheoub ectoftherequest, Wativer Release: lbarehy give permission tier LU above tequo9ilqunictalm conduct an rows criminal emoryleeom check with thoDiAlon ofCriminal favcaugalion(DC0. AnyedmhalhistorydelasonoeretulaethetbmaidlahledbyincDClmaybereleasedasallowed bylaw. WalverSYgnafler5: AILeS'� Iowa Criminal Higtolry Record Check Results As of (— k (!S a search ofthoprovided name and data of birth revealed: No Iowa Criminal History Record found with DCI ® Iowa Wminal History Record attached, DCI IDCiinitlals_ li eceived Time—Jan. 8.-2015-11:55ANI—No, 7587 Q010W'A00T vimmiomdotgay SMARTER I SIMPLER I fiIMMER DRIVEN Office ofDriver Services PO Box 92-041 Deg btoines, IA 50306-9204 Phone: 535-244-9124 186FR532 1121.(E'ax: 515-239-1837 'wwar.kneadotgov Certified Abstract of Driving Record Inquiry Date: 1/8/2015 DL/ID #: 769YY0847 (IA) Customer #: 4292418 Iowa Department of Transportation Name: Allison, Kevan Michael Class: D ID Status: None Address: 621 1/2 BROWN Audit #: 8730680 DL Status: VAL Issue Date: 12/31/2014 CDL Status: None City/State: IOWA CITY, IA 52245 Expiration 11/29/2022 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 621 1/2 BROWN Restrictions: NONE Restriction None Date of Birth: 11/29/1961 Supplement: r'�r Mailing City/State: IOWA CITY, IA 52245 Sex: M.; F. a e 7—� N History Information o -_'ro E a Convictions- ' N Citation Date Conviction Date ACD Explanation counf'I IUR 01/16/2012 _ 02/06/2012 ! ;Improper Registration .Johnson !IA Name: Allison, Kevan Michael DL/ID: 769YY0847 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this Is a true and accurate copy of an official record currently In the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: Frc•"'• :'ai' IOWA 1/8/2015 4 i Office of Driver Services Iowa Department of Transportation Name: Allison, Kevan Michael DL/ID: 769YY0847