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Home My WebLink About16-212IDENTIFICATION NO. /(�—aQ- r 1 (Office Use Only) APPLICATION FOR TAXICAB / 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 St reel Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319)356-5040 (319)356-5497 FAX 1. Name (REQUIRED) (��lSfcP/L,f - �oSo cri P f 2. Address (REQUIRED) 206 beo,,x J i,z AOS 3y T -, L �r 3. Contact Information (REQUIRED) Email:Cell Phone: 711S -71Y94/31? (All written communication gent via email) 4a. Driver's License expiration date (REQUIRED) - b. Taxicab Business Name (REQUIRED) W / 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When vvnal nappenec to me cnarge % (circle one) Convicted Dismissed Deferred Suspended Plead GuiltyOt�g !c�� 7. Have you been arrested / charged with any traffic offenses in the last five years? o Type of offense 44L n Where cn W^heft. What happened to the charge? (Circle one) Convicted 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? %'W 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) 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 cert'�y that I have issued to me by the Iowa Department of Transportation valid Driver's license number 13 �/` QGI issued on (�WLla)1l expiring onc�. I understand that if I falsely answer any qu stions in this application, that this app Icalion 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 provisionq of T'I,jle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date ;�1 STATE OF IOWA ) COUNTY OF JOHNSON ) u crib d and sworn to before me by l t l r I S iD � e r I�LV P f f on this �7 —day of c� x jr.1 1E ota ublic in and !?IA State of Iowa ° L Commissbn Number 221819 My Co - ion spires ��r+xwvn++w+r+eswewt:t�+,x�x�+��+ +ri • rer<rex+++r++,ex+ixw+,�,+<»�.+w�+++++++e+ire+�x+��++++,t�+i��+e++++e+++�+e:�� 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 license '/ /S/?-pI 9 /'. 4 Signature of Police Chi f 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. dtitAGir� � 11�� Signature of City Clerk or designee S/� O/` Date ++»+++++++++++++xe+m++++++«++++++++x+x++++++++++++++++++++++++++r++++++++++++++++++++++++++++++++++e+++xxxm+++x++++++++++++++++xx+x+x++xx+ N O Office Use Only M v Approved application Co Co DCI report State certified driving record nz Website update ry Gan✓rAXIDRIVBADGEAPPL92014amendW.DOC 07/2016 C4J10WADOT www,iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry 9/21/2016 Date: 1809 GRANTWOOD DR Customer 4128411 Mailing IOWA CIN, IA Name: Kakert, Christopher Date of Joseph Address: 1809 GRANTWOOD DR City/State: IOWA CITY, IA Convictions Page 1 of 2 Office of Driver Services PO Box 9204 1 Des Moines, LA 50306-92G4 Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: 713YY7401(IA) CDL Permit Class: None Class: D Audit #: 8236251 Issue Date: 07/08/2014 Expiration 02/05/2019 Date: Endorsements: 3L CDL Permit Issue None Date: CDL Permit 522405959 Mailing 1809 GRANTWOOD DR Address: None Mailing IOWA CIN, IA City/State: 522405959 Date of 2/5/1982 Birth: EXP Sex: M Convictions Page 1 of 2 Office of Driver Services PO Box 9204 1 Des Moines, LA 50306-92G4 Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: 713YY7401(IA) CDL Permit Class: None Class: D Audit #: 8236251 Issue Date: 07/08/2014 Expiration 02/05/2019 Date: Endorsements: 3L CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit CDL Permit None Restrictions: ID Status: EXP Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation County JUR 05/09/2015 X06/22/2015 --TS92 peed Johnson iIA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident DateCase Number JUR 07/22/2014 808929 02/25/2015 1847894 _ IA 11/05/2015 1887776 IA Name: Kakert, Christopher Joseph DL/ID: 713YY7401 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: 9/21/2016 •:A/"4 9/21/2016 IOWA D. f "••'".°ot@_-F Office of Driver Services Iowa Department of Transportation Name: Kakert, Christopher Joseph DL/ID: 713YY7401 Page 2 of 2 9/21/2016 Sep. 23. 2016 11:46AM Div of Criminal Investigation No, 3732 P. 1/2 F QM:I ICY 01 Iowa 6.117 OIarK U1110e Ula 0665.07 09/21/2016 12:60 =Cali P•002/002 STATF, OF IOWA 1.1 a . Request Form 1 To: Iowa Division of Crim in at investigation 'Support Operations Ilureau,11, Floor 219 L. 7111 Street Des Moines, luwa 50319 (515)725-6066 (515)715-6080 Fax am regocsting an Iowa Last N0111C mandatory) ;a-kerf pale Of 131rf11 (mnndator 1311To_ DC) Account Number; _ ' V`A ",,—r L (ifapplicahle) From; City of lows Cit City Clerk's Ofpce '� 410 L. Washington Street IOWA City, iA S2240 Phone: 319-356-5041 Fax: 319-356-Sd97 �— Sos-c-oA ❑Female I q79 - va -796x. rrmver.tnlorntnlronf Without a signed waiver from the subject of (he request, a complete criminal history record may not be releasable, per Code of lova, Chapter 692.2, For complete criminal history record information, ne allowed re law, lay no obtain a waiver ys si naturenotnthesub act of therenest. Waiver Release: i hereby give pcmlisslon for dm abovercpursting olfclal to conduct an Iowa criminal historyrword cheek wide the Division of Criminal Invesligalion(OCI). Any eimioal history date eancrming tel Is mairained by the NCI maybe releasedas dlox w. ed by ta�-- —b I3/RlVer Slgl7 R ltll'e: As of a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ==' lotva Criminal History Record at\tached, DCI t_1aq?_ 01P DCI initials JW DCI -77 (08/25/10) Received Time Sep. 21. 2016 IMPM No. 4469 2i (E)QI ure only U Sep.23. 2016 11:46AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 01054866 COURT DISPOSITION PENDING PAGE I OF 1 CONVICTION STATUS UNKNOWN DATE PRINTED- DCI:01054866 2016/09/23 NAME: ELLIOTT,CHRISTOPHER JOSEPH KAKERT, CHRISTOPHER JOSEPH DOB SEX RAC HGT WGT EYE HAIR SKN POB 19820205 M W 511 190 HAZ SRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE; Y TAT BACK CCH RECORD atv 01 ARRESTED 20160906 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708.2(2) ASSAULT CAUSING BODILY INJURY -1978 TRK#: 1AODNT901 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OP 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 FOR 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 NO No. 3/32 Y. 2/2