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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 ` W 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 L [� hthtm881��_r r Office of Driver Services Iowa Department of Transportation Io Name: Kramer, Gale M DL/ID: 556YY2949