HomeMy WebLinkAbout16-060CITY OF IOWA CITY
410 East Washington Street
<(3
i240-1826
) 356-504 56-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED
IDENTIFICATION NO. ) Lp — 01 f1C)
(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: frit B•��Ij�esa 47 44ell Phone( A5.2VS7,0503
(All written Itommunication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) 7/11 ZO 16
b. Taxicab Business Name (REQUIRED) L4eh&V Ca $ or- to ✓y C%4y
5. Prior experience in transportation of passengers: yrs
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
IV? 0
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
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended ad Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _
Type of offense
2j
Where
When
n.�
(,Y'•
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pipvide the76ame(s)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE BERTIFJED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upoi : request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
0212015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I herebycertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
If yL33'J7�Y issued onWrexpiring on Df/6//�jj . I understand that if I
falsely answer any questions in this application, that this app is ion may be denied. I agree that in making this application, I
consent to allow agents or o es of the City of Iowa City, Iowa, in their discretion, to examine any and all records and
documents relating to thi pplicati n, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the pr isions of 5, Chapt r 2, of the City Code. (Needs to be sig d in f yon of a Notary Public)
Signature ofApp li nt Date__
STATE OF IOWA )
COUNTYOFJOHNSON )
Subscribed and sworn to before me by
S.
on this \% day of
State 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 0 ity of Iowa City (Title 5, Chapter 2, City Code).
E piratio to of auffeur's license l I J 1
3z
or designee Da e
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 f City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
/a� lig
DiAe
n.>
aerasxiDRmBADGE PPre2oiaamended.Doc 0312015
„Ma r. 17. 2016�11,0'JAM��a Div of Criminal Investigation No 9817 p 3;'JO
OS/Yd l20Yg 13. 0.�
142- 1-�/002
STATE OF IOWA , n�
I�
8i Criaraiklal History Beraud Che( -is
Request Form
To: Iowa Divisioll of Ce•bninal CllvesUgatlon
Support Operations Ilurena, l” Floor
215 G. 7ib Street
Des Willes, Iowa 50319
(515) 72,5.6066
(515) 725-6080 Fax
r•
of
1/
DCl Account Number: 'fi00 -•-
(if 7p P-11
Froth: _City of Iowa C'gy
City Clerk's Office
41P Ii. R'ashhliefon Strett
Tawa City, TA 51240
Phone; 319-356-5041
Tax: 319-356.5497
se,,
tlK19kle OFemale z_ -77-
rr (liver trifor%mrlort: Without a signed waiver Prom the subject of the request, a complete erlminal histol y record may not
be releasable, per Code of Iowa, Chapter 692.2. For torn ei'Iminal history record information, as allowed by law, always
obtain a waivers) nature from thesub'ect of ," raauest.
l-Vaiver Releaser I hereby give pcanis n fur the ab,Pc questing arreiel pact ar larva Criminal bi510 retard chte! 7,51�--�
hmcstigallon (DCI). Any viminsl history rains n film ' e tFJlle pivisiga of criminal
0 may bt released Al allo,ved by (Aw. e'
witiver•Sigrral r
l
"t K, ' _S-7 ;nom
As of
)\to Iowa Criminal History Record found with l)CI
lova Criminal Ilistory Record atlached, DCl #
DO initials
13(1-77 (08/25/10)
Received Time Mar.14, 2016 12:51PM No 9606
I
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Iowa Department of Transportation
i 0 [7fte of F)nyef serves (Toil Ffee) M-532.1121
PO Box 2244, Des Moines, to 5U3D5 9;AiM 515,244-5t24
1-It3f.: 515 239 1'831
Convictions
Citation Date
Certified Abstract of Driving Record
Explanation
Inquiry Date:
3/18/2016
DL/ID #:
154BB9768(IA)
Customer #:
639535
Name:
Albright, Ryan Scott
Class:
D
ID Status:
None
Address:
107 S 6TH ST LOT
Audit #:
9114834
DL Status:
VAL
25
Issue Date:
05/27/2015
CDL Status:
None
City/State:
KALONA, IA
Expiration Date:
09/01/2016
CDL Cert Status:
None
522479718
Endorsements:
3L
CDL Med Status:
None
Mailing Address:
107 S 6TH ST LOT
Restrictions:
NONE
Restriction
None
25
Supplement:
Date of Birth:
9/1/1963
Mailing
KALONA, IA
Sex:
M
City/State:
522479718
History Information
Convictions
Citation Date
Conviction Date ACD
Explanation
[oun
]UR
03/03/2012
04/03/2012 592
Seed
Des Moines
IA
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date
Case Number
]UR
09/11/2013
757123
IA
11/22/2013
770413
IA
11/02/2014
824865
IA
02/03/2015
843475
IA
03/09/2015
849593
IA
r -a
Name: Albright, Ryan Scott DL/ID: 154BB9768
Pursuant to Iowa Code 4321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Trarrs'portation, ado
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 IowaDepartment
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: