HomeMy WebLinkAbout16-252�r
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 5 22 40-1 82 6
(319) 356-5040
Q 19) 356-5497 FAX
1. Name (REQUIRED)
IDENTIFICATION NO. f [p-Z5Z
(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
2. Address (REQUIRED) c"F;,C)U 1AW1 I 5W IOWA (tet fi SZ2q O
3. Contact Information (REQUIRED) Email: GWGt1101 Ccn•\ Cell Phone: 319'533 71040
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) k/12- f 2619
b. Taxicab Business Name (REQUIRED) 1(rUcw co'Qd-- (Guy -A Gr,q
5. Prior experience in transportation of passengers: e F rCF m0\1 ZC15 Fe4t `felAw para javA cw y /Rv>a tcer
WOO( 15 Jc +'s 1 REi9- •j4 Frac q cLLw 9Tg A*fp ao aWl-w —c i+ 3
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere /UO
Type of offense
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense Where When
5Nf V,>'L(S WV6141AC-rw CCuWrty t7j3Igu!5-
_('A ILOCC 'FL Cy(!>Iti t�Actr� ci kt,+ IIA 0 11- CKCe ?0 IWA u* j zj I v hpi6
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended lead Guilty Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? &JC3
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 nt rne(s)
)TO .'
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE,GERTIFIED �I
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RENEW ;—
You must apply for an individual Department of Criminal Investigation Report (form available upcWrequ�tj.
I"
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY}
07/2016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby��eerti that I have issued to me by the Iowa Department of Transportati n a valid Driver's license number
SS oti issued on 11;(zlll expiring on 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 provisions of Title 5, Chagter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant _ ( 04__� Date 1(?tel 6
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by �7a t <`u "--ef on this g day of
I 1_. v.. L n. 7N 1 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 th&G4y of Iowa City (Title 5, Chapter 2, City Code).
license I I/ I L / l
or designee
11
co
` W
ate
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.
Signii1tare of City Clerk or designee
Approved application
DCI report
State certified driving record
Website update
// /�/��
-Date
Office Use Only c:
I r4
!/
co
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Clerk/rAXIDRIVBADGEAPPL92014ame dW.DOC 07/2016
to/.Nov.' 3. 2016,( 9:49AMCab,Div of Criminal Investigation (rAX)31933827No.7366
STATE OF •
rtL tt_ ,
)4 k' Criminale Record Check
Request XPorm
'I�,,y!,;.
:r'
To: Iowa Division of Criminal Investigation
Support Operations Bureau, V Floor
218 E. 7ta Street
Dos Moines, Iowa 50319
(515)725-6066
(515) 725.6080 Fax
• _ - Y-.... n.1�6.1 VL...... D.....A n1..nL n
P. 1 / 1'002
DCI Aaaount Number; 9967-F
(Ihpplleeble)
From: Yellow Cab of Iowa City
P.O. Box 428
Iowa City, IA. 52244
(319) 338.9777
Phone;
Fax: (319)339.7302
Last Name (mmdate
First Nome (mandatory)
Middle Namo (ruommended)
KRkMGQ-
6A l,c
M.
Date of Birth (mandno )
Gender mandato
'SoCial•8ecurl Number (recommended
59
iJMale ❑Nemale
4812 -5 �`� L
WalverinformaFm without a signed waiver from the subject of the request, a complete criminal history record may not
be releasable, per Code of town, Chapter 692.2. For complow criminal history -record Information, as allowed by law, always
obtain a waiver signature froth the sub ett of the request.
Waiver Release; t hereby give permission for the above requesting official to 0ondudt an Iowa criminal history record check with the Division of Criminal
IbvWtlsallon (DCO. Any criminal historydata cone! Ing me that h malmdned by the DCI maybe Mewed m allowed bylaw,
WalvarSlgnatareL
(DCI use only)
As of Aa search of the provided name and data of birth revealed:
I No Iowa Criminal History Record found with DCI
❑ lows Criminal History Record attached, DCT
DCI initial—L
DCI-77 (08125/10)
Received Time 00.27. 2016 3:29PM No -6964
QOiUW �.:� DOT
www.iowadotgov
SMARTER I SIMPLER I CUSTOMER DRIVEN.. Office of Driver services
PO Box 9204 1 Des Moines, IA 50306-9204
Phone: 515-244-9124 1 800'532-1121 1 Fax_ 515239-1837
www.iowadot.gov
Certified Abstract of Driving Record
Inquiry Date:
10/25/2016
DL/ID i<:
556YY2949 (IA)
Customer?:
1998958
Class:
D
Name:
Kramer, Gale M
Audit #:
7687981
Address:
2890 HIGHWAY 1 SW
Issue Date:
01/10/2014
Restrictions:
Expiration Date:
01/12/2019
City/State:
IOWA CITY, IA 522407605
Endorsements:
3
Mailing
2890 HIGHWAY 1 SW
Restrictions:
Corrective Lenses
Address:
Restriction
None
Mailing
IOWA CITY, IA 522407605
Supplement:
City/state:
Date of Birth:
1/12/1959
Sex:
M
History Information
convictions
CDL Permit Class:
None
CDL Permit Issue
None
Date:
CDL Permit Expiration
None
Date:
CDL Permit
None
Endorsements:
10/25/2016
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 Conviction Date ACD Explanation
County IUR
12/03/2015 01/07/2016 S92 Speed Washington IA
02/19/2016 03/15/2016 M14 Fail to Obey Traffic Sign/Signal Johnson IA
t«ideets - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date
Case Number IUR
02/19/2016 908962 IA
Name: Kramer, Gale M DL/ID: 556YY2949
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 1 have been auUlor¢ed by the Director of the Iowa Department of Transportation to so certify. N
Name: Kramer, Gale M DL/ID: 556YY2949
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
*: IOWA $�
10/25/2016
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Office of Driver Services
Iowa Department of Transportation
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Name: Kramer, Gale M DL/ID: 556YY2949