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Home My WebLink About16-0794 st CITY OF IOWA CITY 410 East Washington Street Iowa Qty, Iowa 52240-1826 (3 19) 356-5040 1319) 3S6-5497 FAX 1. Name (REQUIRED) ZI-1 2. Address (REQUIRED) Z/O IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB I 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 Middle 3, Contact Information (REQUIRED) Email /h:kc.r„6,ison.cit, Fy "g.j &`-,Cell Phone: tri jG I,r9 (All written communicati sent via email) 4a. Chauffeur's License expiration date (REQUIRED) I Z $/2 nZZ b. Taxicab Business Name (REQUIRED) _ye /lou L A b 5. Prior experience in transportation of passengers: T9 Y; v)-5 , ci o f i Gn rPr.' 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _ q b Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty 7, Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When Other (y No When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other /LI 8, Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prdvide'the name(s)...-, DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED E ' 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 De rt ant of Transpo tation a va d Chauffeur's license number —7-75 YY I y S y issued on 3 Z8 zdY expiring on 3 Z 8Z 8 to�z Z. I understand that if I falsely answer any questions in this application, that this applica ion may be denied. I agr' eA 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 Applican Date N / Z d� G STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed,_ and sworn to before me by _WX on this 11 day of Public A and for the State k*F*F*****#k****£******£*****************************£*#***************x***k***********#******k*k*******k*k**#*#*******£*£****************k*#kk* 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 ' nse N:� � Signature of Police Chief or designe CJ 6 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. � V SignMae of City Clerk or designee t/ e Otte Office Use Only Approved application ~ DCI report State certified driving record , Website update . n ae,wr. XIDRIv AD GE PPre2014dmznded.DOC 03/2015 o3Mar.31. 2016; 9:34AM CabDiv of Criminal Investigation No 1155 P. 1/4 . (FAX)31a3362_ ..,,,,2!002 ohir) n e qB Of Birth tnmdno _00Uder tmandaro.d .3 �cammeneer -`ver Informationunhuti i .. argnaa wWar Irom the subject of tho request, a compiate criminal history record may not be relsaseble, per Cage or Xowa, Chaplcr 692.2. For ao Obtain a waiver sjsnature fro --11815 criminal history -record information, as allowed by Jaw, m tho subject of the requoat, always r<'I�aiveY Release; I haroby Blvc prrmleslon for me above roquejltng oftlelal in condue(ae Iowa alminAl hlSlnryraoord check wllh the DIvI11Dn otCrlmins! Jnvcrlibrrton (DCO. Any orlminel hhrory due eonceming me rhes Is mahalnad by the DCJ may be ralaeaed ae allowed by IoW. Waiver O 2 --��• �+ .-.iac�tc ,Ir,CSU1LS �iujberii» A� of a search of the provided name and date of birth revealed; JZ�7 cn >! No Iowa Criminal History Record found with DCI t �' 0 Iowa Criminal history kecord attached, DCI 9 DCI initials _ (TI OCI-77 (08/25/10) Received Time Mar.29. 2016 4;35PM No.0990 DCI Account Numbers _9967.F TO' town Dlvlsion of Crintlnal Investigation (IraDAllaable) Support Operatlons Bureau, l" Moor FMO" + Xeliow Cab ofIowa Cl 215 E. 71h Street P.O. BO% 428 Des Molnos, Iowa $0319 (515) 725.6066 Iowa Clty, IA, 52244 (515) 725.608D Fax (319) 338-9777 Phone; Fax; (319) 339-7302 ohir) n e qB Of Birth tnmdno _00Uder tmandaro.d .3 �cammeneer -`ver Informationunhuti i .. argnaa wWar Irom the subject of tho request, a compiate criminal history record may not be relsaseble, per Cage or Xowa, Chaplcr 692.2. For ao Obtain a waiver sjsnature fro --11815 criminal history -record information, as allowed by Jaw, m tho subject of the requoat, always r<'I�aiveY Release; I haroby Blvc prrmleslon for me above roquejltng oftlelal in condue(ae Iowa alminAl hlSlnryraoord check wllh the DIvI11Dn otCrlmins! Jnvcrlibrrton (DCO. Any orlminel hhrory due eonceming me rhes Is mahalnad by the DCJ may be ralaeaed ae allowed by IoW. Waiver O 2 --��• �+ .-.iac�tc ,Ir,CSU1LS �iujberii» A� of a search of the provided name and date of birth revealed; JZ�7 cn >! No Iowa Criminal History Record found with DCI t �' 0 Iowa Criminal history kecord attached, DCI 9 DCI initials _ (TI OCI-77 (08/25/10) Received Time Mar.29. 2016 4;35PM No.0990 s CIowa Department of Transportation Once d DffvuSelma (Tdl FteeB OM532-IVI PO Box 5204, Dft MMM, IR 513306-igWll 575-244.91724 AW FA X: 57 5 239 7ii31 CLEAR DRIVING RECORD Name: Robinson, Michael Turner DL/ID: 775YY1494 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 whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: 4� 74/1/2016 r 11ow .. D. Office of Driver Services wear•- Iowa Department of Transporation "'— e.... Name: Robinson, Michael Turner DL/ID: 775YY1494 -- ?l Certified Abstract of Driving Record Inquiry Date: 4/1/2016 DL/ID #: 775YY1494 (IA) Customer #: 2394989 Name: Robinson, Michael Class: D ID Status: None Turner Address: 2100 S SCOTT BLVD Audit #: 7930063 DL Status: VAL LOT 46 Issue Date: 03/28/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 03/28/2022 CDL Cert Status: None 522403017 Endorsements: 3 CDL Med Status: None Mailing Address: 2100 5 SCOTT BLVD Restrictions: Corrective Lenses Restriction None LOT 46 Supplement: Date of Birth: 3/28/1976 Mailing IOWA CITY, IA Sex: M City/State: 522403017 History Information CLEAR DRIVING RECORD Name: Robinson, Michael Turner DL/ID: 775YY1494 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 whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: 4� 74/1/2016 r 11ow .. D. Office of Driver Services wear•- Iowa Department of Transporation "'— e.... Name: Robinson, Michael Turner DL/ID: 775YY1494 -- ?l