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Home My WebLink About16-032IDENTIFICATION NO.. lk (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 Easl Washington Street Iowa city. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319)356-5040 (3 19) 356-5497 FAX First Muddle Last 1. Name (REQUIRED) 2. Address (REQUIRED) 3Za ZnJ 3. Contact Information (REQUIRED) Email.i Sym Qcy S Cell Phone: 315 3"3"3 16 ti tl ll w (Aritten communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 11 117514V b. Taxicab Business Name (REQUIRED) cal Ck4 5. Prior experience in transportation of passengers: t);, 1v Te , 2 '>Ie)tow CA— p)� `nil :;� 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense wJ What happened to the charge? (Circle one) Where When Convicted Dismissed < Suspended Plead Guilty Other Have you been arrested /charged with any traffic offenses in the last five years? Type of offense Where When No C4Sw l`ztnCn C..,rN1vl\1e I i I What happened to the charge? (Circle one) vie Dismissed Deferred Suspended Plead Guilty Other S. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ No Type of offense Where hen r9 -t c y 9, Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prQvlde the-rlame(g) a 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 GOYS'�y (%o I issued on '7110 113 expiring on Ivs War l %V . 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 4RX,A;�_ Date Z I -I I i STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by V , -_ n b- . K u } xA on this 14 day of Public in (nd for the State 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 I/ �` �/� 4 2 /&l ZJ( d Signature of Police of or designee i 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. k�� V SignaluLe of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update a l9 X016 Date aedwrMioRweaocerPPL92014.,ne.d.d.Doc 0312015 �toaT www iowadot gov SMARTER (SEN��F'L�F! I CUSTE?"v�EP P�iPiiEV �-... Office of Driver services PO Bax 9204 Des Moines. IA 50306-9294 Phone: 515-244-9124 1800-532-1121 1 Fah: 515-235-1837 www.lowadoi.gcv Certified Abstract of Driving Record Inquiry Date: 2/11/2016 DL/ID #: 608YY6801(IA) CDL Permit Class: None Customer #: 2110531 Class: D _ ^—` Iowa Department of Transportation CDL Permit Issue None Date: Name: Kaim, Nikita Andrei Audit #: 7118031 CDL Permit None Expiration Date: Address: 320 2ND ST APT 129 Issue Date: 07/10/2013 CDL Permit None Endorsements: Expiration Date: 11/18/2018 CDL Permit None Restrictions: City/State: CORALVILLE, IA 522412657 Endorsements: 3 ID Status: Mailing 320 2ND STAFF 129 Restrictions: Corrective Lenses DL None Address: Status: VAL Restriction None CDL Status: None Mailing CORALVILLE, IA 522412657 Supplement: City/State: CDL Permit Status: ELG Date of Birth: 11/18/1973 CDL Cert Status: None Sex: M CDL Med status: None History Information Convictions Citation Date Conviction Date ACD Explanation 03/08/2013 04/08/2013 County JUR F02 No Child Restraint Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/28/2014 790726 IA 06/20/2015 864871 ie Name: Kaim, Nikita Andrei DL/ID: 608YY6801 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: r:.. .... r'rr IOWA 2/11/2016 ¢ D. O.T.r rf"• " Office of Driver Services _ ^—` Iowa Department of Transportation Name: Kaim, Nikita Andrei DL/ID: 608YY6801 Frb.16� 2016 12:52PM Div of Criminal Investi,ation N o . 7 4 7 6 F. 1%6 Fre..,. _. - 1. olaek —...__ ______-_, 02/11/2019 10:3_ .1103 . ____1002 STATE OF IOWA "t Crilrfinal History record Check � Request Form 3 I)ClAccouneNumber; 4 c5(� 7 —� (if epplicaEte) '1'0: Iowa Division of Criminalinvestigaliun Slrppart Operations Bureau, 1" Fioor 215 C. 7" Soca Deg Moines, Iowa 50319 (515) 725.6066 (575) 725.6080 Fax I a0l 1`60astinc an Iowa Criminal 1-lietav P.—A 01-1. . C'rom: ClEyoffowaCicv CI1y Cleric's office —��--- 410 E. {Washington Street Iowa Cit , IA 52240 Phone: 379-356-5041 FAY: 319-356-5497 Last Name (mandmory) First NAme (nlandalory) Middle Name (reeenmlended) Date of Hirth (mandatory) Gender (mandatory) Social Securi tV N4mber recommended) �1IIFS 173 ElMale ❑Female ''IPSO og Waiver Aformadoij., wilhnut a signed waiver from the subJeet of the request, a complete criminal history record may not be releasable, per Code or Iowa, Chapter 692.2. For complete q•Iminal history record information, as allowed bylaw, always obtain a waiver si nature from the snb act —oft nest. il"fttVer Release; I hereby give permission far Oce One rctimsting otlicisl to conduct w, Imva criminat history record cinch with the Division of criminal lnvcstiestion(VQf Any crimine)hisloaydalawncemingrnoihalis maiQlainedby the DClmoybe relrasedas allowed bylaw. Waiver Bignrelaee " �71u ru Iowa Criminal History Record Check Results Z-161 � (Del use only) As of L a search of the provided name and date of birth revealed: r. iJ1" a C7';'I ❑ No Iowa Criminal History Record found with DCI Ur yt Iowa Criminal History Record attached, DCS#{ t4(4 r C:) DCT initials Co __ `fX1.77 (D8/25/10) — � -- -- Received U me Feb -11, 2016 9:21AM Na 7110 Feb.16. 2016 12�52PM Div or Criminal Investigaf10n ADDITIONAL IDENTIFIERS TAT LF ARM CCH RECORD *** 01 ARRESTED 19991024 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 0,1 IA STATUTE IA7C8-1/236-2 DOMESTIC ASSAULT W/INJURY TRK#: 035763401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING CHARGE CLASS: NON CONVICTION TRK#: 035763401 SENTENCE LISP EPF DAT DEFERRED JUDGEMENT 20000218 COURT COSTS 20000218 PROBATION lY 20000218 DISCHARGED FROM 20000918 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATIONOF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. 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 SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 7476 P. 2/6 IOWA CRIMINAL HISTORY DCI 0044148E NON CONVICTION PAGE I OF 1 DATE PRINTED- 2D16/02/16 DCZ:00441486 NAME: KAIM,DAN KAIM,DANIEL P KAIM,NIKITA ANDREI DOB SEX RAC HGT WGT EYE HAIR SKN POB 19731116 M W 507 201 BLU BRO FAR FL ADDITIONAL IDENTIFIERS TAT LF ARM CCH RECORD *** 01 ARRESTED 19991024 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 0,1 IA STATUTE IA7C8-1/236-2 DOMESTIC ASSAULT W/INJURY TRK#: 035763401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING CHARGE CLASS: NON CONVICTION TRK#: 035763401 SENTENCE LISP EPF DAT DEFERRED JUDGEMENT 20000218 COURT COSTS 20000218 PROBATION lY 20000218 DISCHARGED FROM 20000918 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATIONOF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. 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 SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 7476 P. 2/6