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Home My WebLink About16-113IDENTIFICATION NO ! 1 ffice Use Only) Calt dlliP+71�p' APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday– Friday) 410 East Washington Street Iowa Cily, Iowa 52240-1926 arIUF"G' fFi CC16 it/7tf3(F: LkL YBlIU4CSEi F!Pi'�FFFIaifOtt t4ff1(YeSYfIF_flt r)'e17fal of theafipft;Ci3(F(tte (3 19) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) n VA 2. Address (REQUIRED) N 3. Contact Information (REQUIRED) Email: IOtipffll, vwe one:4S y7J �3S4r (All written communication sent la email) 4a. Chauffeur's License expiration date (REQUIRED) � Ial 1 ILL b. Taxicab Business Name (REQUIRED) _ 1191 ° T- 5. Prior experience in transportation of passenqers i f" (ADGrC 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 4�_ Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested I charged with any traffic offenses in the last five years? I1 What happenearo'Fe Aar e? (Circle one) U° Y fru W I of JW I I Convicte 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 ahen �^ o i ro V 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provId,e-the n9me(4) I I 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 certify that I have issued to me by the Iowa De artent of Transportatio a valid Chauffeur's license number �, 7 4V /��% issued on I I 1 expiring on (�; a IIP 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, an I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the pro s' ns of Title 5,M�Dmn 2, of the City Code. (Needs to be igned in front of a Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by YDrL,1,:2_1 L . C 0ti nrt1� . on this Z Z day 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 of the City of Iowa City (Title 5, Chapter 2, City Code). , _,+1B , Expiration date of Chauffeur's license 01 !2t I 201 T _j d zJ CJ3 Signature of Policb Chief or designee 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. Signature of City Clerk or designee Office Use Only _T) �§ G`f Approved application DCI report State certified driving record Website update cienorA JDRN6ADGE PPL92014nmend.dD°G 0312DI5 r 0OT a+' ViJlftdlN IDWadflt gov SMARTER I SIMM; Ek I CUSTOMER DRIVEN Of li of Diiver Services PO Bo:a 9204 ; Des Momes_ IA 50305-9204 Phone: h15-244-9124 (. $00-532 1121 l Fos. 616-239-1837 +rvrw.larladot �7av Certified Abstract of Driving Record Inquiry Date: 12/9/2015 DL/ID #: 637XX4837 (IA) Customer #: 3558804 Class: C Name: Chipman, Bobbi Lynn Audit #: 7669055 Address: 451 HIGHWAY 1 W APT 30 Issue Date: 01/04/2014 Restrictions: ',IA Expiration Date: 11/04/2019 City/State: IOWA CITY, IA 522464215 Endorsements: NONE Mailing 461 HIGHWAY 1 W APT 30 Restrictions: NONE Address: Restriction None Mailing IOWA CITY, IA 522464215 Supplement: SE City/State: Date of Birth: 11/4/1985 Sex: F History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: IUlt CDL Permit Expiration None Date: FSpeed _ CDL Permit None Endorsements: 08/09/2011 CDL Permit None Restrictions: ',IA ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County IUlt 01/03/2011 02/16/2011 :;592 FSpeed _ !Henry IA 06/16/2011 08/09/2011 592 ,Speed Johnson ',IA 09/07/2011 10/19/2011 .592 Speed Johnson '.IA Name: Chipman, Bobbi Lynn DL/ID: 637XX4837 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: Name: Chipman, Bobbi Lynn DL/ID: 637XX4837 r -a c;7 �•� �EHICLf 0j qi� CC1 ..� f -y u d41 12/9/2015 IOWA w'% 11ZT yl.r�®BN4Q lTransportation SE IowaeDepartmenteces of 9 - Name: Chipman, Bobbi Lynn DL/ID: 637XX4837 Uec.11. 201h MUM U i v oN Grimina,I investigation 1Vo Jluz 2 Fro rn:�a / e+ iewa u,ty Clerk uuioo 31. 3666497 12/l6/201E IA:4$ 0346 P.002/002 STA, TF OV IOWA Criminal History R",ord E"h"k Request Form To: Iowa Division of Qunuml fnvestigalion support Opelaoous Bureau,1" rloor 215 r. P" Street Des Moines, lova 50319 (515) 725-6066 (515)725-6000 Fax 1 am requestinH an Me of Birth (Mand,, -� Gender ❑Mate ar DO AccountN1nmber LC)J (iftpplicalrle) Front: Clty orinwa c1t,•— _--_--_---- City Cleric's office 41U 1';. Washington 9lreel f0WEC'�t5'. lA 52246 Phone: 319-356-5041 Pax. 319-356.5497�- social Securi Number (rel Female 3-13 - C-��q rl alverOtjarmalron: Withouta signed waiver from thesubject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subiect of the eonrreet Waiver Release! i narcby giPo pcnnisslen a abor� ra I nesligadon (DCI). Any criminal hi_slory dalnate Ing m that Waiver Signature: . Oondyol an IOWA Criminal hislnry recnrd check \vii" Ike Division ofCrinlin%I le VCl may be released as Allowed by law. Iowa Criminal History Record Check Results As of /�J. a search oflhc provided name and date of bitlh revealed: No Iowa Criminal history Record found with DC) lnwa Criminal History Record attached, DCl # DCI inilials__4 DCI -77 (08/25/10) Received Time Dec. 15, 2015 1;31PM No.3920 w' r- (I)CI uzc only) „. ND