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Home My WebLink About16-267�r"III CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. 1 (Q — Z-- LO (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 3. Contact Information (REQUIRED) Email: rCX red[' . .r[� 1 , . e�� 1 Cell Phone: (All written cimmu tion sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) \iC\\" J cp Nn 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 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 0 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When 7 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedlead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes,p)balsi 1pr6odtq the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND SATEEWIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Repot (forte ayjilawle upon request) .a._ (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereb certify at I have issued to me by the Iowa Department of Transportation a valid Driver's license number U ��. I 3 issued on 1Z- 2- { (n expiring on I- I - 70)-1 . 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, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 1Z- b -- ((a STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1k, on this LO day of 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). Expirati dat river' license � &_ / ( 0 of Police Chief or designee /Z-/&/ DaYa 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. A�Or� /---- ey,4,� Signbtwe of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date Fs`a i 'A1{J VINN01 E0 Z i,d 9- 03091Ob CleiWrA%IDRNBADGEAPPL92014am ndetlDDC 07/2016 CIowa Department of Transportation 011111m of Dnver Services (Toll Flee) 806.53-1121 PO Box 9269, ties MWres, LA 503069204 515-244-9124 FASO 515.239.1837 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 11/30/2016 DL/ID it: 433ZZ2783 (IA) Customer :7: 3086333 Name: Purdy, Rochelle Class: C ID Status: None Marie Address: 101 N CALHOUN ST Audit O: 6892592 DL Status: VAL Issue Date: 04/25/2013 CDL Status: None City/State: WEST LIBERTY, IA Expiration Date: 04/12/2018 CDL Cert Status: None 527761514 Endorsements: NONE CDL Med Status: None Mailing Address: 101 N CALHOUN ST Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 4/12/1981 Mailing WEST LIBERTY, IA Sex: F City/State: 527761514 History Information Convictions Citation Date Conviction Date ACD Ex lavation W Coun ]UR L07105/2012 107/2312012 IS92 iqeed Scott IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 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 beset •uPon this document, at Ankeny, Iowa this date: ,.,,7 11/30/2016 M Q. 0. Office of Driver Services Iowa Department of Transporation Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 ,,1 3 ;.0i �£ .C� 1-IIJ 9- 390 910z tu ,� Oe C. 5. 2916011:41AMCebDiv of -Criminal Investigation No. 8670 P. 1/1, (FAX)3193382..._ /002 \ Tot Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 Z. I" Street Des Moines, Iowa 50319 _ (SIQ 725.6D66 (SIS) 725-6080 Fax - � -Z�— '8 ( I ElNlale a DCI Account Number; 9967rF ' ' (Irapplle"biel irromi Yellow Cab or Iowa Clry P'O. Box 428 Iowa Clty, U, 52244 Phones (319) 338-9777 Fax; (319) 339-1302 Waiver Irl f, per Coda Without a signed waiver from the subject or (he request,•a complete grtminal history record may no obtain ain asabia, per Code arlowa, Chapter 692,2. For co to crlmllial hletory,record Information, ON allowed bylaw, always ostein a waiver alanatls Isom theaybiect of the reouast. Walyar Release; I hereby glue permission fbrtht above requertlns ofilclal to conduei an IOWA Criminal history record Aback Wilh t)o Division Of Crimtnel inveallsallon (DCI), Any Crlmle of hlnory dare conacmine me ;hal is mslnialned by the DCI may be released v elloweil by law, Walser Signafure As of. ) a, ! 111 (a a search of the provided i and date of birth revealed;, No Iowa Criminal History Record found with DCI 13 Iowa Criminal History Record attached, DCI #, )JCI initials r � � DCI -77 (08)25/10) Received Time Nov, 30. 2016 11:13AM No. 9063 CD (DCI use only)