HomeMy WebLinkAbout16-200CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) .
2. Address (REQUIRED)
IDENTIFICATION NO
iL2-on
(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
First s
u\
3. Contact Information (REQUIRED)
Middle
Last Nn
tr,
rgot -ti 1„tl,,t m
communication sentWA email)
4a. Driver's License expiration date (REQUIRED) 02 -OS -2-02,3
b. Taxicab Business Name (REQUIRED)
r
5. Prior experience in transportation of passengers: ADO
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?�`
Where
What happened to the charge? (Circle one)
When
oS- 2f
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
Other
When
What happened to the charge? (Circle one)
Convicted Dismissed DeferredSuspended Plead Guilty Other
8. Has your driver's license or chauffeur's license been suspended o ed in the last five years?
Type of offense
Where
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, pleasept'vfde the
A D19
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)
07/2016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I her �py certi that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
`1i51 fl g issued on [ expiring on 02-2.05 -2-3 . 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 prollr ions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applican Date I "$-1 1[P
#Y#441!1!11Hf}}R}f##H}4+#Y#Y##ii4HfYlMf}}F}##}#+}}Y#}#iiiii4f4lfi44f#4f}lfllf!!!}R#+#}+H####Yii###ii4fi44if4ff}}f}}R+}}##}##Y}}i#1fi#Y1411f
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscri ed and sworn to before me by i i C,_ I 1 I on this c`J' — day of
Snip
KELLIE K. FRUEHLI t of ry Public in and the State of Iowa
My
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 Driver's licenseSf 2�
(a4iV�
Signature of Police Chief or designee
ff L8/277�� -6
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.
-K . f
Signature of City Clerk or designee
Date
N
Office Use Only i•^ �■�rp�
Cn Y
Y
Approved application�—L� 1
DCI report P_ -o M
State certified driving record — 3
Website update
GerM/rA%IDRNSADGEAPPL92014anwdetl DOC 07/2016
C� ,nr., , DOi
SMARTER I SIMPLER I CUSTOMER DRIVEN www,iowadot.gov
Inquiry Date: 8/26/2016
Customer #: 6074392
Name: King, Candice Ellaire
Address: 75 PRAIRIE RIDGE CT
City/State: NORTH LIBERTY, IA
523179691
Mailing 75 PRAIRIE RIDGE CT
Address:
Mailing NORTH LIBERTY, IA
City/State: 523179691
Date of Birth: 2/5/1964
Sex: F
Convictions
Office of Driver Services
PO Box 9204 1 Des Moines, IA 50306-9204
Phone. 515-244-91241800-532-1121 1 Fax: 515-239-1837
www.lowadotgov
Certified Abstract of Driving Record
DL/ID #:
932AL0225 (IA)
CDL Permit Class:
Nom
Class:
D
CDL Permit Issue
None
B51
No Driver's License
Date:
IA
Audit #:
1260621
CDL Permit
None
Johnson
IA
Expiration Date:
Issue Date:
08/26/2016
CDL Permit
None
Endorsements:
Expiration Date:
02/05/2023
CDL Permit
None
Restrictions:
Endorsem�n,ts:
3
ID Status:
None
Restrictions:
NONE
DL Status:
VAL
Restriction
None
CDL Status:
None
Supplement:
CDL Permit Status:
ELG
CDL Cert Status:
None
CDL Med Status:
None
History Information
:station Date
Conviction Date
ACD
Explanation
County
JUR
)4/26/2014
05/28/2014
B51
No Driver's License
Johnson
IA
)2/12/2015
03/,05/2015
B64
No Insurance Card
Johnson
IA
Sanctions
Type Effective End ACD Explanation Occurrence JUR JUR
suspended 12/04/2014 07/09/2015 D53 Non -Payment of Iowa Fine IA IA
Name: King, Candice Ellalre DL/ID: 932AL0225
Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Dlrec .Ir 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 tills document, at Ankeny, Iowa this date:
Q�EPICIf p�`y�e
8/26/2016
?4 IOWA.. -
k, p........
Office of Driver Services
Iowa Department of Transportation
Name: King, Candice Ellaire DL/ID: 932AL0225
Sep. 1. 2016 10:08AM Div of Criminal Investigation No.3144
06/27/2016 11;45Yel lo„' Cab oP Iowa City (FAXj3153352708
9
STATE OF IOWA;jos ...itDtln;rY'Criminal History- • •
Request Porm
yVjf�f�11:'::
To: town Division of Crllalnal lnvestika'don
Support Operations Bureau, 1" Fluor
215 C. 7rb Street
Des Moines, Iowa 50719
(515) 7256066
(515) 725-6080 Fax
P. 1/1
P.002/002
DCr Aocount Number; 9967-k_'
(Irappllcable)
From: Yellow Cob o£Xowa Clh
P.D. Box 428
Iowa City, IA. 52244
(319) 338.9777
Phone:
Fas:: (319) 339.7302 w
f
' bZf••; ; tutionr Wlthoue a bigned walver•from !he'subject a>'tho rogpest, a complota criminal hl;:•
'rq :n;:.' .,ar Codo'at Iowa, rhoptcr e9.1r2. For c9'nni2tp artmtnal history•raoor¢ Infornatlon, as a;°4'n• ". a s`,..}' "
i ilv slalialure frofn the sub ect of the request._ —
( :x:r4't; 8�ea3s; I hcmby give pemtbshi(•d; s • .1va raqumlIng olllclal to olIdool an IOWA ertminAl hBloryrocord cheek with the Division of i�+mWarl
r aa,Fs lo; (dor,. My cdm,nbl history dau•.fio:to••. 'A,a III Is nglntslncd y c DC1 may bo ralowed m ollawaa by law,
I 91dlver Signafxr..'• .,; ! Lee:
Iowa Criminal Histc.r-y Record Check Results . ' -`-]
A5 of__, - A- .lx - , e searalb of :' 1 arovidod namo and date of birth r®vodt
r
No Iowa Criminal History Record found with DCI
d Iowa Criminal History Record attached, DCI l
1
DCI initiala_��'
DCI -77 (08/25/10)
D r; ., A 17 'tnl( 11.6215A6 hl 1765
(Doll 019 Only) ..