The URL can be used to link to this page

Home My WebLink About15-101r _e t (1mfr®4 It � alMl®i�il CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3191 356-5497 FAX IDENTIFICATION NO. P5- ft�>I (Office Use Only) APPLICATION FOR TAXICAB 1 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 /FAt-J 1. Name (REQUIRED) 2. Address (REQUIRED) 9 l 3 Contact Information (REQUIRED) EmaiP Ln WO (All written 4a. Chauffeur's License expiration date (F b, Taxicab Business Name (REQUIRED) 7 7 K'I 2. S k/ C1 Lo Jw4 munic on sent email) Cell Phone: 3j 2 -s' -6o 0 ;1 - email) L 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? ) J Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty /'Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Jv1t/ IJ Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? °t% O Type 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 STAT�`EIRTIF,D T% DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE Mf REVIEW --4 ao� r 1 * You must apply for an individual Department of Criminal Investigation Report (form avajgle� u 3 reaxraat). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTAR� �%� 11 Co 02/2015 1. APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I herf y gqert�fy YV I have issued to me by the Iowa Depart ent o,1 Transportation,a valid Chauffeur's license number J G' / 7-5-3 issued on / /S expiring on y��Z�,�y? I understand that if I falsely answer any questions in this application, that this application may be denied. Igrey e 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions off Title 5, Chapter 2, of the City Cod@- (Needs to be signed in front of a Notary Public) Signature of Applicant �/,c °/` � 4� Daley y STATE OF IOWA ) COUNTY OF JOHNSON ) bed and swore. to before me by Yc ri Lk ,, itir,r ,eon this 7'4�k day of Public In land for the State of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 12, City Code). 7 —7 / Expiration date of Chauffeur's license i ! / ?z /in Signature g ol} e C of -df designee .s /C( 5 Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Aa. �_P. Sig Lure of City Clerk or designee /-s e Da Office Use Only o Approved application y -c DCI report State certified driving record n"Z Website updateze `gym v j'' cm CY! ClertJ JGRIVBADG6 PPL92014amended.GOC 03/2015 05/Ila ivw LUio 2, ie�iuw�lCab uli4 iuwe flmlpol 111YCS[IgdI 100 No.6�1d P. 1�5 Y (FAX)3193382�uo r.�u2/002 � , XOWAis a sRequest Form Tot Iowa Division of Criminal 1nvolltigatlon Support Operations Bureau, 1" Floor 215 E. 7i4 Street Des Maines, Iowa 50319 (515) 725.6066 (515) 725.6080 Fax I a(n YEe OEaeine an I.. I M..— n.. -_..J IL__i_ _ DCI Account Number: 9967-F arappucabla) Fromi _Yellow Cab of Iowa City P.O. Box 428 XOwa City, IA. 52244 (319) 338.9777 Phone: Fax: (319)339-7302 Last Name (mandato) First Name (mnodete Middle Name (reco,nmAdcd) As of l �� a search of the provided name and date of birth rovoaled: rA Date of Birth mende,e Gender (m'�ndaia i 'Social -sec Number (reeommended) '� Z U Male❑Female Wa or inform loft: Without a signed waiver from the subject of the request, a completo erlminal h1story record may not be eleasable, per Cade of Iowa, Chapter 692.2, For complete erlminal history record Information, at allowed by law, always obtain a waiver from signature the sub set of the ro uesA WaiverReieaSetlhereby g:vepeonlsoioato( thoobov ueatingorcclalt000nduaenlowaorlminalhhtoryrccotdoheckwldllheDlvlstonofCrlm' inal lnveatlrwion (I)CO,Mycdminol history dala oanoemin a ails maia nI 'nod by pCI maybe relaeod d nllllowa bU' WaiverSlgnafurr, ,f�"' Iowa Criminal History Record Check ReNults (DOIuse only) As of l �� a search of the provided name and date of birth rovoaled: No Iowa Criminal History Record found with DCT r., �L;; �, =e cn cam � ❑ Iowa Criminal History kaeord attaohed, DCI # C o zsz DCI initials r� DCI -77 (08/25/10) Received Time May. 5. 2015 3:29PM No. 7171 CIowa Department of Transportation AO ofte DT D4fver semcm (TDII Free) 8!]0-532 1121 PC BDY. 92144, Des Moines, IA 5G306�92U4 515-244-9124 %A7(: 515 23@ 1837 Certified Abstract of Driving Record Inquiry Date: 5/5/2015 DL/ID #: 701YY1753 (IA) Name: Madden, Patrick Class: D CDL Cert Status: George CDL Med Status: None Address: 3009 12TH AVE SW Audit #: 8757468 APT 102 Issue Date: 01/13/2015 City/State: CEDAR RAPIDS, IA Expiration Date: 11/22/2017 524041460 Endorsements: 3 Mailing Address: 3009 12TH AVE SW Restrictions: Corrective Lenses APT 113 Date of Birth: 11/22/1950 Mailing CEDAR RAPIDS, IA Sex: M City/State: 524041459 History Information Convictions Customer #: 2857327 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD I Explanation Cou nty IUR 05/03/2013 05/30/2013 M42 Improper Lane than in lanes Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number ]UR 05/03/2013 737766 IA Name: Madden, Patrick George DL/ID: 701YY1753 Pursuant to Iowa Cade §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: