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Home My WebLink About16-0114 It MMM®��Il CITY OF IOWA CITY 410 East Washington strect Iowa City. Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) 3. Contact Information (R IDENTIFICATION NO. (Office se 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 se via email) GVVA 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 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? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? y& Where X C k.A When 77 What happened to the charge? (Circle one) I Convicted Dismissed Deferred Suspended Plead Guilty Otherj ;Jr -8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 13-4, L� t /C 4 Type of offense Where When G� 216 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prbvid6 thFiname(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE-CERTIFI[D71, DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upoinrequest). _j (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I her ye c rti th t I,�hi ve issued to me by the Iowa Departm nt of Transportation a valid Chauffeur's license number (11 i2`d issued on U expiring on e' y I understand that if I falsely anssWdr any questi ns 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 ICyz t Zd ,t,J Z' Date 012c)14 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by )Ce.tc.,,, �, 4i1,`�e on this J -o day 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 2, City Code). Expiration date of Chauffeur's license {� rr L / �Z2� Signature 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. mow, �,2 k . u / Signa + of City Clerk or designee Office Use Only Approved application DCI report State certified driving record n, Website update clerk/rAXIDRNBP G6 PPL92014amendea DOC 0312015 Page 1 of 2 � UVVA . DOT •. SMARTER l ;rF+I ClS7igFl.ftPdv iowadotv ll Office of Driver Services. PO Box 9204 i.. Des f14011"IeS, kA 50306-9204 Poore. 115-244--W24 1801,532-1121 1 Pax, 511,-2`?9-1817 Inquiry Date: Customer Name: Address: City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: Certified Abstract of Driving Record 1/6/2016 DL/ID #: 769YY0847 (]A) CDL Permit Class: None 4292418 Allison, Kevan Michael 621 1/2 BROWN IOWA CITY, IA 52245 6211/2 BROWN IOWA CITY, IA 52245 11/29/1951 M Class: D Audit #: 9136520 Issue Date: 06/03/2015 Expiration 11/29/2022 Date: Endorsements: 3 Restrictions: NONE Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Allison, Kevan Michael DL/ID: 769YY0847 CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: COL Cert Status: CDL Med Status: None None None None None VAL None ELG None None 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: g{ IOWA D. 0. T. Name: Allison, Kevan Michael DL/ID: 769YY0847 ra 1/6/2016 cn N '✓ Office of Driver Services - Iowa Department of Transportation --7 1/6/2016 Jan. I I. /UI0 II IhHIVi Oiv of Criminal Investigation N'o.51Ih P. 1 :�ve.u�...�.y ... �..wn ..uy clerk .......e .e.e 01/Oe/20ie 93:4. v363 —02/002 S'S'AiLE OF Criminal History record Check Request Form To: Iowa Division of Criminal Investigation Support operations Hureaty I" Floor 215 E. 7"i Street Les ibloines, lows 50319 (915) 725-6066 _ (515) 725.60@0 Fay 1 au) reouestine an Iowa Criminal Idistory Record Check on: 1XI Accopnl Number: F' (if applicable) W From: Ci(Y oP Iowa City _— City Clerk's Office 410 E. Wadhineton Street Iowa City, YA 52240 Phone; 319-356-5041 Fay; 319-356.5497 Last (n,andalory) First Nanie (inandawy) AliddleNarge (recommended) fNanle '1 g — f"Vey( '�aj Dateof)3irth (mandatory) y) dr' bna Genl�endomry) Nainber (rec/erded) Social SecLwi ommn ( l 2 /�' (�Ia1e ❑Female Waiver IltforMafion: Without n signed waiver from the subject of Ilio request, a complete criminal history record may riot be releasable, per Coale of Iowa, Chapter 692.2. For complete crlmival history record information, as; allowed by l2m, always oblast a waiver sl nature from the subject of the request. Waiver ReiepSel i hereby give permission for the above regneving official (o conduct as lova criminal history racord cheek with tlm Division of Criminal blvcgtiga(ion (A(:I). My criminal history Bala conuming me Thal is maiulained by the DC7 maybe rdcased as allowed by law, WaiverSigfiandre: SSC vl _ ,--__l I N Iowa Criminal History Record Check Results (DCl use only) As of 1, �� a, search of the provided Dame and datc of birth revealed: —Z t No Iowa Criminal fiistory Record foand with DCI - ❑ Iowa Criminal History Record attached, DCII c DCI initials`�, CID' c.rt DCI -77 (DS/25/10) Received Time Jan. B. 2016 12,36PM No,5043