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Home My WebLink About16-074� r �AMP-am®� III ccmcrh N1w®��'\ CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX IDENTIFICATION NO (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 j p� Middled 1. Name (REQUIRED) First`Jel-r 2. Address (REQUIRED) 2CG2 e4 v k S 7, t 3. Contact Information (REQUIRED) Email:.r,,, 14 p „ .L,0, (All written commu cation s 4a. Chauffeur's License expiration date (REQUIRED) Z-Zc -,201 b. Taxicab Business Name (REQUIRED) __ e �� Last Cell Phone: 3i 9 f4y- oqo y email) 5. Prior experience in transportation of passengers: c. o,k Leen «moo r /O s 6O Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 1Nha l appenede charge? (Circle one) ^ E,r, aQ t y E -W"- Convicted Dismissed efe a Suspended Plead Guilty OSh6r 3 `rte 7. Have you been arrested / charged with any traffic offenses in the last five years? n e Type of offense What happened to the charge? (Circle one) Where When 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? Type of offense Where When Z, Y. , 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide theTbme(s)v'"� DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED d 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) 0212015 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 3cCl )t )/b !2- issued on 3 - 1,71 expiring onZ-z 6_ /c2 . 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%� �� —z Date 7— / STATE OF IOWA ) COUNTY OF JOHNSON ) SV4scribed and sworno tbefore me b �J�1 i— / i �� r � y I_`��+ l;—'P � on this � day of Iz sionNurober221519 Notary Public in and for the State of Iowa t' r My Go °•'Y6w� 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 02 I z(L, D r q t. W97S Signatu of Police 13hief or designee 04 61 c, Date AFTERAPPROVAL 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. Signn&ture of City Clerk or designee Approved application DCI report State certified driving record Website update t/�- /iz Dafe r� ca Office Use Only w aer MDRivenocraaPr92014amanded ooc 03/2015 - no aer MDRivenocraaPr92014amanded ooc 03/2015 o3/Ma r �I 31. 20164, 9.34AMCeb Div of Criminal Inv e s t i g a t l o n No. 1155 P. 214 -' "" (Fq%)37933n2iuu r,uvi/002 �4STATE OF • Criminal History Record Check, 1 Request Form Tot Iowa Dlvlslon of Criminal Investigation Support Operations Bureau, lu Floor 219 9. 7" Street DOE M0111e9, Iowa 50319 (515)725.6066 (61S) 726.6080 Fox I am roeueatino an 1nWG r`rIm teal Vias,,,., D ----J nr.__,. _ DCI Account Number: _ 9967—F drspplrcabie) From; Yellow Cab of Iowa cltv F0. Box 428 Iowa City, IA. 52244 . (319) 338-9777 Phone; Fax: (319) 339-7302 - - _- ........... Last Name mendele) B'irst Name ftand,10M Middle Name (reiwmmendad %xPEl� .II__ • 1 - a✓1 /� V 1 Date of Hirth (mendele Gander (Mandatory) social, Number recommenaea -1 e- 4JMale 01temale 8.193/ W41verXnformailon. without a signed waiver from the subject of the request, a complete Criminal history record may not be releatablod per Code of Iowa, Chapter 692,2. For oomplalo erlminal hlatory-recor(1 information, as allowed by law, Always obtain a walver sl nature from the subject of the request. WafverReieaS& I herebysive petmfsdlon for the above requauing oalalor to conduct an Iowa odinlool hfdlory record cheek with the 01v(slon ofCtlminel Invudgallon (DCO, Any erlminal Ninety dela oonceming me lhal Ir mslnulnad by tho DCI maybe released as allowed by law, Waiver Signaturat Towa Criminal Hiss try Record Check Results (ocl use only) r.. As of - o , a search of the provided name and date of birth r@yhaled` , 0 No Iowa Criminal History Record found with DCI C? N_ Iowa Criminal History Record attached, DCI 9 DCI Initials_, _ 4„ DC7 -77 (011/25/10) Received Time Mar -29. 2016 3:51PM No.0963 Mar.31, 2016 9:34AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00683845 NON CONVICTION PAGE 1 OF 2 DATE PRINTED- DCIo00683645 2016/03/31 NAME: KUIPER,J6PF MICHAEL DOB SEX RAC MGT WGT EYE HAIR SKN POB 19750226 M W 511 140 BLU BRO MI ADDITIONAL IDENTIFIERS TAT BACK CCH RECORD *** 01 ARRESTED 20021025 AGENCY: IA0520200 IOWA CITY PD CHARGE NO— 01 IA STATUTE IA124-401(5) POSSESSION OF CONTROLLED SUBSTANCE I TRK#: 100690201 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.901(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID. 06521 SRCR063709 CHARGE CLASS: NON CONVICTION TRK#: 100698201 SENTENCE DEFERRED JUDGEMENT PROBATION lY COMMUNITY SERVICE 25P DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED 20050119 AGENCY: IAD52020D IOWA CITY PD CHARGE NO— 01 IA STATUTE IA124.401(5) POSSESSION OF SCHEDULE I 2ND OFFENSE TRK#: 101406601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— O1 IA STATUTE: IA124.401(5) POSSESSICH OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR071188 CHARGE CLASS: NON CONVICTION TRK#: 101406601 SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY DROP REGULAR UA -S DISCHARGED FROM DEFERRED JUDGEMENT DISP EFF DAT 20030304 20030304 20030304 20040816 DISP $FF DAT 20050708 20050708 20060731 No. 1155 P. 3/4 na c -a q7 r s,. C.F 1 2ry - rV Ma r. 31. 2016 9;34AM D l v of Criminal Inv e s t i g a t l o n No. 1155 P. 4/4 DCI 00603645 PAGE 2 OF 2 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, SUREATJ 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 m h Iowa Department of Transportation i 0 [Y� Uitim .N Urroer S[rsl{cs {.Toll i ftiei bs . 591 1121 130O132CMii, Urn .Mt rim 1h 5f1tiCh°,r9,2ti.Jfi 51.E 2A4 L1)f24 I-V': 515 til 1 W I CLEAR DRIVING RECORD Name: Kuiper, Jeff Michael DL/IIl: 35OWW1842 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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 whereas, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: IOWA Sr ; :. D. 0. T Name: Kuiper, Jeff Michael DL/ID: 350WWI842 3/29/2016 r Office of Driver Services - , - Iowa Department of Transporation ..J Ln � nT . !V Certified Abstract of Driving Record Inquiry Date: 3/29/2016 DL/ID #: 35OW W 1842 (IA) Customer #: 1209464 Name: Kuiper, Jeff Michael Class: D ID Status: None Address: 2662 BLAZING Audit #: 7839378 DL Status: VAL STAR DR Issue Date: 03/01/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/26/2019 CDL Cert Status: None 522406848 Endorsements: 3 CDL Med Status: None Mailing Address: 2662 BLAZING Restrictions: Corrective Lenses Restriction None STAR DR Supplement: Date of Birth: 2/26/1975 Mailing IOWA CITY, IA Sex: M City/State: 522406848 History Information CLEAR DRIVING RECORD Name: Kuiper, Jeff Michael DL/IIl: 35OWW1842 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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 whereas, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: IOWA Sr ; :. D. 0. T Name: Kuiper, Jeff Michael DL/ID: 350WWI842 3/29/2016 r Office of Driver Services - , - Iowa Department of Transporation ..J Ln � nT . !V