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Home My WebLink About15-072�+.®iGO CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX /r Authorization Number (Ofilue use Only) y 1 APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday– Friday.) First Middle Last / 1. Name �c`ut a, 1 2��LICF �lC-1r, 15�-,(w0 2. Mailing Address , [� //�� > (A�—L,l 3. Telephone: Home l / / L Other: v 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N U Type of offense Where When 6. Have you been onvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? AJ� Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? A ) O Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? rA[4 ) Tvoe of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(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) cledda.tdwbad9 03/2014 I here jy certifv that 1 ha p issued to me 7y the Iowa Department of Transportation a valid Chauffeur's license number /4 T 6�Z 7 1 understand that if I falsely answer any questions in this application, that this appncati n 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 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 front of a Notary Public) / 1 Signature of Applicant Date b S / (/ YOU ARE NOT VALID TO DRIVE A TAX A CITY UNTIL AUTHORIZA ON IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at Icgov.org. STATE OF IOWA } COUNTY OF JOHNSON ) Sub ribed and sworn to before me by-7eorgc- ��/C_� rc7° On this �7 G� day of Ll K. TUTT" Number 221819 otary Public in and for the State of Iowa 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). Signature of Poli e rdesignee pry/ly 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 legov.org. Signatu of City Clerk or designee �Ay/zy Oate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'h" (width) and 5%11 (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update cl.Mk idrivbadgeappM4.d°c 03/2014 osrM. 20145,11:48AMcdb•Div of Criminal Investigation ion STATE OF IOWA Criminal Aistory Record Check Request Form To: Iowli Alvlsion of Criminal Investigation Support Operations Burenui I" Floor 215 S, 7'" Street Des Moines, Iowa $0319 esm 725.6066 a 0 (FAX)3S93sZz7No. 0348 P•, .?02/004 D 0 Acoourit Number: _9967-F (if applicable) From: 'Yellow Cab of lows Clty P,O. Box 428 . Yowa Cltye U. 52244 tatyl aeo-o e r r Phone: Faza (319) 339-7302 ilrth(mandamiy G?p dorendato fisaelal•Securi Nurnber(mcommeeaea Male ❑Femalo R �f r(formal on: Without a algnod waiver from tho aubJeat of the request, a complete criminal flstoryowed record may not bte, per Code of IOwPii Chapter 692.2. For or mntele criminal history roeord Information, as allowed by law, ntwaya obtasn a waver at nature srum "w sum eew. we WaJVO(Rslea5a: forthe ebova roquwthng official so conduct an Iowa criminal historynaoid cheek wide she Dlvlslon of Criminal Invaaligatlon(MO, Myorlminnlhhrrry(1elaconoomingmeIhetbmalmalnadbytheDalmayberckmwasallowedbylaw. w-�� _-......... Wolper Slgnalurel As of a search of the provided name, and data of birth revealed: No Iowa Criminal History Record found with 1)CI ❑ Iowa Criminal History Record attached, DCI # I)CI DCI -17 (08/25110) (DCI ura only) Iowa Department of Transportation C7ttrce of DryaefServi-ces (Trill Free) 81U0 5 2 i12i '-° RD BOX g21CY4 Dee M01fi "', i 50306-i[Mii 514.244-9124 i._ RM: 511"'.239 183'r CLEAR DRIVING RECORD Name: Bickford, George Frederick IV DL/ID: 70OA30627 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: y�E1C IF by 5/15/2014 10WA 1. L 7Ir D. 0. T.441 cej4wyt s l�&IV Office of Driver Services Iowa Department of Transporation Name: Bickford, George Frederick IV DL/IO: 700AJO627 Certified Abstract of Driving Record Inquiry Date: 5/15/2014 DL/ID #: 700AJ0627 (IA) Customer #: 6101512 Name: Bickford George Class: D ID Status: None Frederick IV Address: 401 9TH AVE Audit #: 7011629 DL Status: VAL Issue Date: 06/06/2013 CDL Status: None City/State: WELLMAN, IA Expiration Date: 01/15/2018 CDL Cert Status: None 523569338 Endorsements: 3 CDL Med Status: None Mailing Address: PO BOX 296 Restrictions: NONE Restriction None -Supplement: Date of Birth: 1/15/1967 Mailing WELLMAN, IA Sex: P1 City/State: 523560296 History Information CLEAR DRIVING RECORD Name: Bickford, George Frederick IV DL/ID: 70OA30627 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: y�E1C IF by 5/15/2014 10WA 1. L 7Ir D. 0. T.441 cej4wyt s l�&IV Office of Driver Services Iowa Department of Transporation Name: Bickford, George Frederick IV DL/IO: 700AJO627