The URL can be used to link to this page

Home My WebLink About16-209CITY 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. I C—'a 01 (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 J.v 3. Contact Information (REQUIRED) Email: e,, Ye�4+lTyt 1, t"Cell Phone: (All written sent via email) 4a. Driver's License expiration date (REQL b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa L--/ (I)sQ-7317 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? What happened to the charge? (Circle one) Convicted Dismissed eferred Suspended Plead Guilty :r Other ni i 7. Have you been-wFootedd charged with any traffic offenses in the last five years? i < S : , Type of offense Where W t t 3 16 We, Lc 2 D J, � vv� At happ ned to the charge? (Circle one) Dt vQ Convicted Dismissed Deferred Suspended lead Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? d 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 name(s) �IC) 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number ::17 �[!d/ 3(„ issued on f2_3o"/5�expiring on L /�- Zd 17 . 1 understand that f 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, Cha ter 2 of the City Code. (Needs to be signed in front /of a Notary Public) Signature of Applicant Date 0 tn o� STATE OF IOWA COUNTY OF JOHNSON )-P Subscribed and sworn to before me by q_� on this f�� day of �pl�t '-7 r,l l-0 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 Drivers license le ✓z e - Signature of Police Chief or designee l`-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. Sign re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update aa/ ate ClerkrrAXIDRIVaADGEAPPL92014am ded.DOC 07/2016 09,SeP._15•. 20164-5:46PMCabDiv of Criminal Investigation (FAX)3193362No.3138 STATE OF • HiCriminal story Record is Requesta rm Tot Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 215 U. 7'a Street Des Molnea, Iowa $0319 (515) 725-6066 (818)725-6080 Fax I am raquestina an Iowa Criminal History Record Chnnir nm P. 1/2,/002 DCI Account Number; __9967-F • • - Of applleablo) From) Yellow Cab of Iowa City P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 Phenol Fax: (319)339-7302 ,Ia99t Name mandate First Name Mine Middle,Name (rbeommondad)' �' V-leVK G��(as Date of Birth mandato 1 Gender (mandatory) &oolal•Seeurl Number reeommende Ll '2114 l OMAN ❑Female $T `OtS f /Myer l;ifutwiation., Without a signed waiver from thesubjoct of the regpost, it eomplgte orimi4al history Peer•; ,l .r!; .'o be releasable, per Code of [owg, Chapter 693.2, For comole(c erimU,al histuryreoor(1 informatlou, se gllowut by ; .ways obtain a walvar signature from Ike sublact of the request. !!'utver Release; I hereby give pesmissloo invenlgallon (DCO. Any cdminet hlnery data og Waiver Signature; w Lo wndu t an Iowa criminal history record check with ft Dlvlslon oWrimina( fir l a I loey be re woa by law, (DCI use only) As of I I�� 1 �� a search of the provided name and date of birth revea�ed: ❑ No Iowa Criminal History Record found with DCT - Iowa Criminal History Record attached, DCI # ' �0 �� 3 Ti 1 7n Dcllnitlalshc -- D01-77 D01.77 (08/25/10) Received Time Sep. 9. 2016 10:49AM No, 3600 Seo.15. 2016 5:47PM Div of Criminal Investigation No.3138 P. 2/2 IOWA CRIMINAL HISTORY DCI 00763235 NON CONVICTION PAGE I OF 1 DATE PRINTED - 2016/09/15 DCI:00963235 NAMEz DECHARD,JHREMY J REW,JEREMY NICKOLAS DOB SEX RAC MGT WGT EYE HAIR Sm POB 19841230 M W 507 230 BRO BRO XX ADDITIONAL IDENTIFIERS TAT R SHLD CCH RECORD *** 01 ARRESTED 20051104 AGENCY: IA0520200 IOWA CITY PD CHARGE N0. 01 IA STATUTE IA714-2(4) THEFT 4TH DRGRER TRK#: 101698901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(4) THEFT 4TH DEGREE - 1970 COURT CASE ID: 06521 5RCR074228 CHARGE CLASS: NON CONVICTION TRK#: 101698901 RESTITUTION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20060303 PROBATION lY 20060303 20060903 DISCHARGED FROM 20061011 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS POP 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 /AL,'. Iowa Department of Transportation Vmce of Dnvef Services f Ioil Ffeei 800 532-1121 PO Boa! 9204, Des Manes. IA 50306 9204 515-244-9124 FAX 515 239 1837 Certified Abstract of Driving Record Inquiry Date: 9/19/2016 DL/ID #: 775YY4363 (IA) Customer #: 1424101 Name: Rew, Jeremy Class: D ID Status: None 12/1412007 Nickolas 851 No Driver's License Muscatine lA Address: 2A� MUSCATINE Audit #: 8727168 DL Status: VAL 11/30/2012 12/28/2012 M14 Fail to Obey Traffic Sign/tonal Johnson IA 0 2013 03/2E2013 2013 Issue Date: 12/30/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 12/30/2019 CDL Cert Status: None 522402801 Endorsements: 3 CDL Med Status: None Mailing Address: 2804 MUSCATINE Restrictions: NONE Restriction None AVE Supplement: .Za Q. e...... 1y 3w i avt Mailing IOWA CITY, IA Sex: M City/State: 522402801 History Information rnnvirfinne Citation Date Conviction Date ACD Explanation 1county JUR 16/2007 09/12/2007 B51 No Driver's License Muscatine SA 12/1412007 01 00. 2008 851 No Driver's License Muscatine lA 63/11"2008 o4 GS two o5i iry viiverb iiiEi iSc --ulrc iA 11/30/2012 12/28/2012 M14 Fail to Obey Traffic Sign/tonal Johnson IA 0 2013 03/2E2013 2013 S92 Speed HenryIA 09 27 2014 01/09/2015 S92 S eed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Rew, Jeremy Nickolas DL/ID: 775YY4363 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: ' E 1% 9/19/2016 ►: IOWA N. j h.. Office of Driver Services `w•"• Iowa Department of Transporation Name: Rew, Jeremy Nickolas OL/ID: 775YY4363