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Home My WebLink About16-101'��Fs®ll � CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-IS26 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. / ( 12- lsjl (Office Use Only) APPLICATION FOR TAXICAB f 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 First g {f /l Middle J 1. Name (REQUIRED) dcJDfgU p 2. Address (REQUI RFD) /DCJ/ Cre7sSl 10,4rJ- AVP 3. Contact Information (REQUIRED) Email: I►6o��Y 2r1[� r(I �qM (All written communication -sent 4a. Chauffeur's License expiration date (REQUIRED) 1 I /Zo b. Taxicab Business Name (REQUIRED) Ye �i0/Cy i A-/ d 5. Prior experience in transportation of passengers: _ CAD 0� r Je Last nl /e 411, Carr` Cell Phone: 3(5' ` lq -73Z(o via email) 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere Iles osse sst a Lf When lgcl r What happened to the charge? (Circle one) Convicte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years d S erg trh'11f What happened to the charge? (Circle one) Where Towrt-CI When 7-oi Convicted Dismissed Deferred Suspended Plead Guilty Other //NlAle 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? r� Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the nan�t ;(s) ,yo _ DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED- DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REWEV You must apply for an individual Department of Criminal Investigation Report (form available upon _tequestf (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) e' 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby ce tha I have issued to me by the Iowa De a m nt of Transportation a valid Chauffeur's license number � �f1 _7 issued on /3 expiring on :J%! —ZQg . 1 understand that if I falsely answer any questions in this application, that this applica Ion 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 f Title J, Chapter 2, of the City Code. (Needs to be sigg din f ont of a Notary Public) Signature of Applicant Date G✓/ / 1(a I ^ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Ml� aalb ._-_\<11 Public in on this 01-\ day of of Iowa `71311'1 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 1/ /)" 1 6j Signature of Police Chief or designee '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. Signa a of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ClerkffAXIDRIVBAD G EAPPLffi014amended. DOC 5` 7 D to 04,Apr,20. 2016 g 11: 1 JAM Cab DIV of Crirn fnal Inv est lgaf 100 (FAK)3183382N0'2345 P. 1/1,/002 rtuiry,� Check 'FI!r.`a�. OF IOWA Crimi;i:�6:I,�i;;t c. mac_ cr l'l1'da��f•; i .HistoryRecord •IEy� p sForm Tol Iowa Division of Criminal Invesllgatlon Support Opsratlons Bureau, l" Floor 115 It. 7`4 Street Das "olnet, Iowa 50319 (515) 7256066 (615) 725.60110 Fox I am reguestins an Iowa Criminal fllstory Record Check nn. AGI A000unt Number: 9967-F of epplicabfel Froml ]'allow Cab oflowa Clty P.O. Box 428 xdwa City, IA. 52244 (319) 339-9777 Phone Fax, 019)339-7302 its Name (mladaloy)I C First Name tneodaiaryy $6 a. Middle Name (rocommeded) i Date te7of Birth (mendalcry) / �Z A% Conder mandato Male 111retnalo3 '600fal'se,curi Number recommended) Z p2— � -75-01 rratver inlarmatton. Without a signed weilver from the subject of the regpest, a compl4le grtmtnal history record may not be releusabfa, par Code origwa, Chapter 692.2. For c obtain a waiver signature from the sublect or the remleeomplote *rim lnal histary,record information, as allowed bylaw, always I'�Q1vBr,�el@trSe; I helaby gSve permission fot the Ibove Invudasllon (DCI). Any atlmJoel hlnary data concemlaefna t Walver 1116 conduct an Iowa criminal binoy record cheek with Iho olvlslon of ComIn11 by the DOIm be released as allowed by law. 27 ". (DCI use only) As of qza search of the provided name and date of birth revealed; yp No Iowa Criminal History Record found with DCI is ; ? ".. r�... •_ ❑ Iowa Crimihal History Record attached, DCI # c DCI initials r- tn DC1.77 (08/25/10) Received Time Apr,19. 2016 2:59PM No 2661 Inquiry Date: 5/17/2016 Customer #; 5937812 Name: Riley, Bobby Joe Office of Driver Services p;_, Box, &C-'-'4 Cies rAoif FafJ3fia-+2134 Pmol n'5 A4 of24 1 �Gf, It2i Fa•.:5=5-2 Rkh'i i1f'e'auol `:!jo'l Certified Abstract of Driving Record DL/ID i#; 690AJ9763 (IA) Class D Audit #: 6909763 Address: 1053 CROSS PARK AVE APT Issue Date: 05/01/2013 B Expiration Date: 07/21/2018 City/State: IOWA CITY, IA 522404486 Mailing 1053 CROSS PARK AVE APT Address: B Mailing IOWA CITY, IA 522404486 City/State: None Date of Birth: 7/21/1967 Sex: M Convictions Endorsements: 3 Restrictions: NONE Restriction None Supplement: None History Information CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: Office of Driver Services CDL Permit None Endorsements: t',Y CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None citation Date e:,uxxwrct¢u: Daae 7a'T.D C',mAxt;' JUP 01/27/2014 05/07/2014 M14 Fail to Obey Traffic Sign/Signal Johnson '.IA Name: Riley, Bobby Joe DL/ID: 690AJ9763 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: Name: Riley, Bobby Joe DL/ID: 690A39763 VkN. '. ,..... 5/172016 IOWA :?', F lIBIVEP S Office of Driver Services Iowa Department of Transportation - - t',Y