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HomeMy WebLinkAbout14-2501 � i �r w ®Ili t illi A_ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Authorization Number 4 � ' l aa�- ct(Office Use Only) t� 7/t APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday.) as ¢rem t�orr� (etau._9CrCE°ra.r� 1�a�m.a�'� ata9'¢�u�rarma�fb"rwa'a wrok� rt:��ra�f /rt ¢/ee�sa�___�..�.__. First 1. Name (11B.")UIRE'i)) 2. Mailing Address (RE'QUIRED) 3. Contact Information (REQUIRED) Email 4. Prior experience in transportation of passengers: Middle Last 0--"2.2q 5 Gi t/ �i _ G�II Phone: �{ it CC �d ed r(�(�c°� e—C I✓ Ve, %tA U c 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have yoconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? u be Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? y 1,$ When Type of offense Where When (Al :>5 L 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prougk the)i t hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I understand that if I falsely answer any questions in this application, that this application may be denied. I understand 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 y nd all records and documents relating to this application, and I further agree that, if a license is granted, to comply at all m with of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date � YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHOR0\TION IS RECF VED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOVVA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by On this ...1 day of N®Je.1.,,1A a,®- as 0 t W I have reviewed this application, OCI 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). Signet ,e f'Police Chief or designee 4r Date 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 icgev.org. Signature of City Clerk or designee Da e Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width) and 6 %" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update CIerWTAXIDRNBADGEAPPL92014amerged.DCC 09/2014 Nb v. 10. 2014 10:45AM Div of Criminal Investigationf STATE OF } A Criminel History Recor'd Check Yom- To.- Iowa Division of Criminal Investigation slapport Operations Bureau,: oo Imes Molacs, Iowa 50319 7264066 6Isa Fam Il:ovrra C°ruaxaanwl &. 131680 IP. `1/1 DCIAccouatNumber: —F (feepptla0b1c) Fromm ,...I ft�owR!NC y....... City C erfea ofkdc© 410 :9. WarCuGrv�knarer 1.0.n.�'d4yx...TA.. ���4bd. Meow 319 -396 -Aad Fax; .wy9-Wdd'497 .1101 a rgavwrq , f al flax", GG�uk)uorpt o Wgfied Waiver from thaaobje t of the roakeuesl, a earnpleto Haat criirM J8kory record may pear peer Goats of.Iow o, Chapter6,92a, Gear emrr .le e& ; erfansrrat Idstory me:ord rnthrrumotlorr„ or AlEowcd by MawD eagwawoys BftltydA` �G:�"��u��"up Il Nsmameoyphwugyasauonpsstwra IfnmcaYC�o.nPube�rt��,�6uugt�etrs}iata9AvCsmatreBuduaoo offfesordorovidad A rwn sh"�uuamkNuV.sP. ynr. zarYaecYcvu}urca �➢.7dvsd ¢vefff,rGniadeenN ADW wy be eoMmadai xII nmd be=fm. AS of ............... --101 „ a ,, .mp oh of the fpr. -o .ded na nee wxA dato ofMyth .x:eveale& R,�,G Cdr �,ly�rm, Ca„It'ttunpa� �'�1�tor�'R�a;eaar�ef, �taexra� 4d�.'.Iy�� M, MT, 1 M.? /80/94!1 Received Pune igov, 3. X1014 3:09PM No -3337 tlowa K)liepairtnierd of Trans port a"H1011 Mot alf ll'inferSaurtica s i'Fuh ReOI IM*532 1121 FK) Box 9211M,, Dilif Munimi, KAr 503016-10M 5,15,10 0 i2s C3 RNQ 51!15,234P, M37 . . ..... .. . . . . Name: Blake, James Allen DL/IDN 749PJ3552 < Pursuant to Iowa Code §321.10, 1, Kim Snook, Director of Office of Driver Services, Iowa Departmini,,of Transportation, do hereby certify that I am the custodEan of the records held by the Of of Driver Services, that this Is iiruiano,"' pcurate copy of an official record currently in the custody of said Office, and that I have been authorized by the Director'of the I a 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; "I"t 11/3/2014 it I'M Ire D Q.T.1- s' Office of Driver Services Iowa Department of Transporation Certiried Abstract of IMiriiivffig Record Inquiry Date- 11/3/2014 DL/ID #g 749A73552(IA) Customer #z 6159996 Barran Blake, James Allen Class: D 10 Status: None Address: 324 E DAVENPORT Audit #: 7493552 DL Status: VAL ST APT 4 Issue Dalai: 11/02/2013 CDL Status: None clity/Stata; IOWA CITY,, IA Exphration IDota. 10/11/2018 Mi. Cort Staturn None 522452.108 Endorsements. 2 CDL IMed Stamm None Mailing Address: 324E DAVENPORT Restrictions. NONE Restriction None ST APT 4 Supplement: Date of Birth: 10/11/1961 Mailing IOWA CITY, 1A Sex: M City/State: 522452108 Hilstorr VInformation . . ..... .. . . . . Name: Blake, James Allen DL/IDN 749PJ3552 < Pursuant to Iowa Code §321.10, 1, Kim Snook, Director of Office of Driver Services, Iowa Departmini,,of Transportation, do hereby certify that I am the custodEan of the records held by the Of of Driver Services, that this Is iiruiano,"' pcurate copy of an official record currently in the custody of said Office, and that I have been authorized by the Director'of the I a 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; "I"t 11/3/2014 it I'M Ire D Q.T.1- s' Office of Driver Services Iowa Department of Transporation