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Home My WebLink About16-039► r mfr®� 77rr A �®1�� "Ok CITY OF IOWA CITY 410 East Washington Strect Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. t^ (Office Use Only)— APPLICATION n y) 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: 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa (All commu le Phone: ZI9 qdo R 91 6. Have you ever been arrested /charged with any misdemeanors and/or felonies in this State or elsewhere? What happened to the charge? (Circle one) au° Convicted Dismissed Deferred Suspended lead G p� Other o` 7. Have you been arrested / charged with any traffic offenses in the last five years? ! V!) 7,; f Type of offense Where When 715 What happened to the charge? (Circle one) % Convicted Dismissed Deferred Suspended Plead Guilty Other AA // 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ✓ Vn Tvpe of offense Where When 9. Have yoVever 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 I&A t a I have issued to me by the Iowa De a m nt of Transportation a valid Chauffeur's license number rO �i i y3 issued on J )' expiring on �d/g f 1 I understand that if I falsely answer any questions in this application, that this application may be denied.ag eY f 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in roont of a Notary Public) Signature of Applicant Date JI V STATE OF IOWA ) COUNTY OF JOHNSON 1 cribed and sworn to before me by eoc(L ) �� on this d 1 v� day of (F, i ,-e k { I .t'k" KEW K. TyaEL . Notary 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). license to I of 1 I I re kLEpkLZhief or designee 212 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. Signatu City Clerk or designee Approved application DCI report State certified driving record Website update 2 i Dat Office Use Only c C.0 cizmrrn IDRIVD oGEAPPFs2014amanded.Doc 0312615 S� cizmrrn IDRIVD oGEAPPFs2014amanded.Doc 0312615 of/tF=6.17. 21) 16. 2:52PM Div of Criminal Inv - sti,ation a DCI Iow.Nc.1611 F r-1 STATE OF IOWA Criminal History Record Check _ Request Form Tot tom Division or Crimlaal I■veatleunua Support Operadoue Baraeo,l" Floor ars L 10 Street Des Moines, low■ 50319 (AM 71"M (515)12MI110 Fat( .. I�...o lL:..,I.el i11se...., tl..•...,t !`F...4 ,...: DCl Amount Number: hf.eplloeNe) prem, (Ma rfe5 Tdll(i 116 5kC-C ,s Dr- pbonee ,(314 338- Fasl. • 519 551 0 Last Name to) FYnitNamp > Middle Now rE�aaoarAa Date or Hirth Gender Social SecurityNumber 10 11LIe ❑Female �� UI ' r 7 ^J •SZ Wgfwr.W0rmaN0Nr Without a elped waiver Prow the subject or the mgont, a ewaptete cdmmst history regard mey eat be releasable, per Code or Iowa, Chapter 691.L For r9alp$A erhalael history record leformanon, ar allowed by law, always elo a "Alver el eture 11'oYt The sub ecr ottbe request. Walpe7 Reledse. I Aveby r(ropmlubn ra oe eboreiegantey oRte l to ewdun wIom cnmhrl rbtmy W=ord me;twlm do Dtrblm afCd dral InVoUptlon(DCI). Mq cruuicd b1107 den wKm/u/jngllpnedmfls rMNo lmd by the DO tMy be Mleied u 6110w od ty lur, WalvorS Signature; Iowa Criminal History Record Check Results As of it search of the provided nama and date of birth revealed: 0— No Iowa Criminal Hislory Record found with DCl ❑ Iowa Criminal History Record attached, DC14 DC1Initials o) Received Time Feb, 15. 2016 10'09AM No. 7306 (DCI rue only) C410WADOT A.fP "TEF I `IMP ER I " 'ST?MrI DRIVEN C3ffiCF of Driver Services PC, SLS 92O4 ! Des 6raifi IA 15C--,V-92G4 Phone, 575-244.012418GG-532?429 , Fa... 5t5-239-189: Certified Abstract of Driving Record Inquiry Date: 2/24/2036 DL/ID #: Customer #: 5108020 Class: Name: Ruth, Cody lames Audit #: Address: 607 WESTGATE ST Issue Date: 07/18/2014 CDL Permit Endorsements; Expiration Date: City/State: IOWA CITY, IA 522464627 Endorsements: Mailing Address: 607 WESTGATE ST Restrictions: NONE DL Status: Restriction Mailing IOWA CITY, IA 522464627 Supplement: City/State: CDL Permit Status: ELG Date of Birth: 10/8/1989 None Sex: M None Name: Ruth, Cady lames DL/IO: 846AA4243 846AA4243 (IA) COL Permit Class: None D CDL Permit Issue Date: None 8268722 CDL Permit Expiration None Date: 07/18/2014 CDL Permit Endorsements; None 10/08/2018 CDL Permit Restrictions: None 3 ID Status: None NONE DL Status: VAL None CDL Status: None CDL Permit Status: ELG CDL Cert Status: None COL Med Status: None History Information CLEAR DRIVING RECORD 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: Name: Ruth, Cody James DL/ID: 846AA4243 2/24/2016 IOWA D. 0. T....'&-11 P �... $ � Office of Driver services �1h �_____�� Iowa Department of Tra n sportati on