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HomeMy WebLinkAbout15-145CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. (,s--- ('-(,S— (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 1. Name (REQUIRED) �_ 2. Address (REQUIRED) �q0 uF `TZ Last 5�� "a 3. Contact Information (REQUIRED) Email: bie�h, 1?`0^sJ"erz1kQ jM".1 Cell Phone: 3 rR - q4. 71f 16 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 6/u/ 13 b. Taxicab Business Name (REQUIRED) _ iell�„ eg6 vt Z.,, C� 5. Prior experience in transportation of passengers: Tt+ g, yc ra �Qs:� dr,,'V� 'kkL[ ,b 1a� C,)y 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Where When 0 w What happened to the charge? (Circle one) 97 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 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? Po 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 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number y{3 " 1� ©999 issued on "a 113 3 expiring on 6 /il J t } 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 the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date -712-9120), - STATE OF IOWA 1 COUNTY OF JOHNSON ) Su scril ed and sworto before me by 4 Ui n s j7- on this a-1' day of a./L Public in 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 Ch eur's license Signature of Police Chief or designee o/7 5 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. / lftu�z-,w r1 '/�Jt�l Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date aer�axiDRI eADG FPLszmaamended.Dac 03/2015 C410WADOT www.iowadotgov SPA ^aUf`l I �,`ili I (.uA ra 4f°.I•)i Office of Driver Services. FO Eon 9204 i Les Moines, I 5030E-9204 Phone: 595-244-9124 1 BCD -1-32-1921 1 FaX www. iowadot.gov Certified Abstract of Driving Record Inquiry Date: 7/24/2015 DL/ID #: 753MM0999 (IA) Customer #: 5033602 Name: Schuetz, Kevin Eugene Class: D ID Status: None Address: 2904 HEINZ RD Audit #: 6134497 DL Status: VAL Issue Date: 07/18/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 06/11/2017 CDL Cert None 522408122 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2904 HEINZ RD Restrictions: Corrective Lenses Restriction None Date of Birth: 6/11/1977 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522408122 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Number �Uk 03/01/2013 .728336 IA Name: Schuetz, Kevin Eugene DL/ID: 753MM0999 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: �"*' "44 ''';fOW'IX 7/24/20115 IOWA .>r, D. 0. T..:",r r BflNtR � Office of Driver Services a�..�*� Iowa Department of Transportation Name: Schuetz, Kevin Eugene DL/ID: 753MM0999 Jh1.11. 2015 10:12AM Div of Criminal Invesfigafior No. 3303 11 1/3 From:Clty of Iowa Cloy Clark nfelco 219 36e'&497 07l1e/aPls 14'. 117 016 P.002/002 STATE Of IOWA @ Requnt Form Criminal His(ory Cheek Iowa Division of criminal Inve'Mption 9eppol'( Opera(icos floreau, f i1 Clow. 215 L„ 711, Slrect Des Moines, [owe 50319 (515) 725-6066 (515)725-608(1 Fai I alit reeneSGnn nn inaa C,•i,n Intl lY:.r,..., n..,,.._a nl--- ,. _ DC) Account Number: _ W ooes_ _— (if�pplicablc) Frum: City f )owg City -------- ---._.— City Clerlcl$ Office 410 !r. W4shinVoo Sireel lnwa Cil I IA 52240 llhuiie: 319.356-5041 Fat: 31.9-356-5497 -- — -- aSC Name (mandnlorY) �.'ll•st R'ame (mnndalory) — nild dlC Na)110 (recommended) bate of Birth (ma salon) gender (nlaadawry) Social SecurtNunlber (_^ I2COmmended) 061111 /r% {SlMale ❑�cmale z 'W' S2 S Rl1'EI' XfIfMIMIfWIN Without s signed waiver from Ilse subject of Phe request, a CotpplelC criminal hlslOry record may nal be reldasable, per Code of laevo, Chapter 692.2. For complete criminal his(ory record infm'matlon, as allolved by law, alavays obtain a waiver signature from the subject of the rc2uesl. *aiVCr'Release: I hereby give penniseion for At above regncaling offsoisl co conduct all Iowa criminal history rowrd cheek wi,h the Division aferiminal Invesligatieu fM). Any aiminal hislory data mnetrnine,ne alal it maiulained by silo DCI maybe released as allowed by Ia,, )')/af VCI'�il$7laflll'C: -- 1O'W2 Qirflinal Histar r Record Check Results - (L) (Uel use only) As of '����_�r�— a search of rhe provided pante and dale of birth revealed; ❑ No Iowa Criminal Histury Record found with DC) t'' Iowa Criminal IM) is(orylteeord attached, UC;1 7 ,JLr/ r (usioilu) o.,.,.:—J 7:— 1,l 14 11116 1. 111 OCA 1,1„ 1111 I Ju1�17. 201: 10:12AM Div of CriI�inal Investigation No.3309 F. 2/3 IOWA CRIMINAL HISTORY DCI 00604412 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2015/07/17 DCI:00604412 NAME; SCHUELTZ,KEVIN EUGENE SCRUETZ,KEVIN SCRUETZ,KEVIN EUGENE DOH SEX RAC HGT WGT EYE HAIR SKN POB 19770611 M W 602 230 BRO PRO LGT IA ADDITIONAL TORETIP12RS CCH RECORD *** 01 ARRESTED 19990823 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSE CONT SUBS I TRK#: 046841901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESS SCH I CONTROLLED SUBSTANCE -MARIJUANA COURT CASE ID: SRCRO52673 CHARGE CLASS: NON CONVICTION TRK#: 046641901 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19991201 COURT COSTS 19991201 PROBATION 1Y 19991201 DI$CHARGED FROM 20000912 DEFERRED JUDGEMENT 02 ARRESTED 20011016 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 Owl TRK#: 100369301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; !A321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE TD; 06521 OWCR060201 CHARGE CLASS. MISDEMEANOR CONVICTION TRK#: 100369301 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 2D 20011129 FINE $1000 20011129 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVEOTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. Ju1.17. 201') 10:12AM Div of Criminal Invsstlgatlon IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SU8,7RC`C OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 3303 F. 3/3