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Home My WebLink About15-102► r �sG®d1� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. ! J —/[pg, (Office Use Only) APPLICATION FOR TAXICAB / 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 3. Contact Information (REQUIRED) Email: 649 -cam/ Qr�blh�tYlcl� ytf«c`%t "�7Cell Phone: (All written communication sent via email) 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? I✓62 Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where V-9 2 -2-r" C" �. When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other �pr 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? two 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 RQ le(s) A/ -,o 0 � r'n DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE �IFIE® DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C K' E1(NW You must apply for an individual Department of Criminal Investigation Report (form (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) L!? w 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I he reb c�Ify that I have issued to ine by the Iowa Dep�rtme t of Transportation v li Ch uffeur's license number Y� rgfeVI ssued on a( x0i�xpiring on 07'x . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of (fie City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by 1_1AAPS_ (t,_ iI Inu on this/�An day of and for the State of Iowa 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 2, City Code). Expiration date of Chauffeur's license 0? -03— a0 Sign ure of )T Chief or designee 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. Cl.n MIDRWBADG�PPr92014am.W.d.DOC 03/2015 .va (�_S at = of City Jerk or designee Date 0 Office Use Only `D rn m S Approved application 4= DCI report TP State certified driving record Website update Cl.n MIDRWBADG�PPr92014am.W.d.DOC 03/2015 17JIUWADOT SMARTER �rMFUR I cusTOMeF aRIvtra;m wwwliowedotgov OfTiLe of Driver Services PO Box 9204 j Des Moines, IA 50306-4204 Phone- 515-2445-124 2.D0-532-1121 I Fay. _ 515-239-1837 www.mwadotgov Convictions Gita:i Kin Dat@ 12/16/2012 10/05/2013 Conviction Date 01/09/2013 10/29/2013 Name: Lenihan, James Edward DL/ID: 082860656 History Information ACD E:tplanatian County IUR S92 Speed _-- Johnson IA 592 Speed _. _.. Johnson _.. 'IA _. Pursuanan of the t 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 office land that I havoe rds been)authorized blce of Driver y the Director of thesIowaDepartment of Transportation to that icopy so cert fy ficial record currently in the custody of said 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: 5/12/2015 Certified Abstract of Driving Record D. 0.T `�-g Inquiry Date: 5/12/2015 DL/ID #: 082BB0656IA % Customer #: y Name: Lenihan, ]amen Edward Class: p 1563118 Address: 2976 BLACK DIAMOND RD Audit #: 8975239 ID Status: None SW DL Status: VAL City/State: IOWA CITY, IA 522408454 Issue Date: 04/02/2015 CDL Status: None Expiration Date: 03/03/2020 CDL Cert Status: None Mailing Address: 2976 BLACK DIAMOND RD Endorsements: Restrictions: 3 CDL Med Status: None SW Corrective Lenses Restriction None Mailing City/State: IOWA CIN, IA 522408454 Date of Birth: 3/3/1960 Supplement: Sex: M Convictions Gita:i Kin Dat@ 12/16/2012 10/05/2013 Conviction Date 01/09/2013 10/29/2013 Name: Lenihan, James Edward DL/ID: 082860656 History Information ACD E:tplanatian County IUR S92 Speed _-- Johnson IA 592 Speed _. _.. Johnson _.. 'IA _. Pursuanan of the t 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 office land that I havoe rds been)authorized blce of Driver y the Director of thesIowaDepartment of Transportation to that icopy so cert fy ficial record currently in the custody of said 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: Name: Lenlhan, James Edward DL/ID: 082BB0656 5/12/2015 IOWA *til D. 0.T `�-g .... f -`-' BigyEP,_ Office of Driver Services y Iowa Department of Transportation Name: Lenlhan, James Edward DL/ID: 082BB0656 May. l3� LllI7 II:7UANi Div of Grlminal InveStigatinn No. 7086 P. 3/3 Fi _...._—......e ... ......1 06/12/2016 13no poet. P.002/002 ,STATE OF ][AWA _, Criminal History record Check 14Request Forf11>+ To: Cowa Division of Criminal lnveatigaiion ' Vppnrt Operations Bureau, V Floor 215 C. 7`^ 3h'ecl Deg Willes, Iowa 511319 (515)725.6066 (515)728-6080 Fox lam L F?9L` ht70'l. :a.ecora L leex on: First Nanie (mar V� Gender (manda,on DCI Account Number: t -f (if AdpliCahE) Flom: Cifv of Iowa CitV City Clerk's Office -nw 410 F. Washington gtrecl IOWA City, fA $2240 Phoue: 3)9-356-5041 Fax: 519-356-5497 ❑Female: �'u c6 �- �� yT %5 Wniver Injornantiour 'Without a signed waiver from the subject of the request, a complcic criminal history record may no( be releasable, per Code of Iowa, Chapter 692.2, For complete erltnioal history record Information, as allowed by haw, always obtain a waiver signature frmn the subject of the remtest. g/river Release: 1 bgeby give permission for the above reque5l198 ofLcinl to coodura w Iowa criminal hinory record check crirh the flivision of Criminal Isimligalion (DCI). Any criminal history data ennaraing nu Thalia mauoaine(l by the DCtmay c rcicasad as allowed by Inv. WaiverSignaftvr'e:__ Iowa f.:riminal History Record Check ][results As of -r/� _ , a search of the j)rovided name and date of bitch revealed: 0 No lotveti Criminal Aistory Record found with DCl ❑ IOWL Crialinal Ris(Oiy Record a(lached, DCl tt DCI initi _ DCI -77 (08/25/10) Received Time May.12, 2015 1:05PM No. 7694 (L)Ci use only) <-_ U c� r— I. �n