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Home My WebLink About17-029��G®d1 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3191 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO i-7 -Q�L-9 (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) 320 Zn� ST A -pr IZg 3. Contact Information (REQUIRED) Email: ®yrvl , C ^, Cell Phone: "3(c( 33 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 1 I I 1 d 17-01 g b. Taxicab Business Name (REQUIRED) Klr"er Uri E CAP> 5. Prior experience in transportation of passengers: 231L, IS- -tA>-t , 'f"u'1 6h%, Oil 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? iz s Type of offense Where When P•., /hs stilt �.rra�+.l1e X01 1={yy What happened to the charge? (Circle one) o Convicted Dismissed rte Suspended Plead GuiltyOtheC4 Have you been arrested / charged with any traffic offenses in the last five years? u b . : o Type of offense Where What happened to the charge? (Circle one) Convicted Dismissed Deferred -"-en — tl Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? IJO 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) N� 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 Koss Yr tbo\ issued on 7t w t%% expiring on 11I 1�5 t I2� . 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 v/"r�W Date _Z111 Irl STATE OF IOWA ) COUNTY OF JOHNSON ) �Wqscribecl and sworn to before me by ;1C. �t� A . ! •r. AA on this Z) day of (ua! 17.. for the State of Iowa IA 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 �� V 2ol 0 Signature of Police Chief 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. �igq�rP of Ci Clerk or designibe Date tv Office Use Only r'l 7 - co .. } : N Approved application DCI report — -a State certified driving record r Website update -' w 0 W GerklrAXIDRIVa4DGEAPPL92014amended DOC 07/2016 D /CAd00n4' A••T www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1 8OD-532-1121 1 Fax: 515-239-1837 w w_iowadol.gov Certified Abstract of Driving Record Inquiry 1/31/2017 DL/ID #: 608YY6801(IA) CDL Permit Class: None Date: Customer 2110531 Class: D CDL Permit Issue None #: Date: Name: Kaim, Nikita Andrei Audit #: 7118031 CDL Permit None Expiration Date: Address: 320 2ND ST APT 129 Issue Date: 07/10/2013 CDL Permit None Endorsements: Expiration 11/18/2018 CDL Permit None Date: Restrictions: City/State: CORALVILLE, IA Endorsements: 3 ID Status: None 522412657 Mailing 320 2ND ST APT 129 Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing CORALVILLE, IA Supplement: CDL Permit ELG City/State: 522412657 Status: Date of 11/18/1973 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. %ccident Date Case Number IUR ---Ji-64871 _ 790726 _ _ �- -_-- --_-- _-_--� - - - IA )6/20/2015 864871 � IA Name: Kaim, Nikita Andrei DL/ID: 608YY6801 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: 1/31/2017 IOWA D. 0. T. r Pp lIAIVE7f $ Office of Driver Services Feb. 3. 2017 3:44PM Div of Criminal Investigation No,2926 P. 2/5 FYom;Clly or lowp Clly CI OYK Offlca 319 3666497 Ol/31/2017 12;21 x813 P.0o2/002 F'Or STATE i. I f �r 7oum i:. WA CI : History � Record Request Form DC) Aeccunt)Jumber; opt (if applicable) 7'd; lolva Division of Criminal investigation From; Ctty oflowa_ Cite Support Operations 1)ur•eau, I11Floor City CIerICs Office 215 L. Ira Street 410 E. Washington Street Drs Molnes, Iowa 50319 (ai 7ys-6066— — _T ,.'-(3tyw.Iis2244 (515) 725.6090 Fax Phone: 319-356-5041 Fax: 319-356-5497 1 am renuectino an Tm"a 0,,;... inol T - Mt.,,, n .—A r•r..,.l, __. Last Name (mandatory) Mrrst Name (mandatary) Middle Name (recommcaded) Gender mandalory Date of Birth (mandalory) Social Security Number (recommended) it •7 •y Waiver Xnjarfnnfioff: Withou(a signed lvatver from the subject of the request, a corople(e cr(mhnal history record may not be releasable, per Code of Iowa, Chapter 692.2. For coo etc orhnihal history record Information, as allovl ed by law, always obtain a waiver signature from (lie subject of the request. Waiver Rele=: I hereby give pconission for the above regues6ng onnciauo conduct an tows criminal hi:torp ruord clock win, the Divflion orCrinlinsl Invotigulon (DCI). Any cfmbnat history dale canumiug me lhal is maiwained by the DCI maybemleased as allowed bylaw, —` -� •�. .....�1..,. �awvau vue{.r1 AXIOMMt:D (UCl use only) As of a` a search of the ,provided name and date of birth revealed: =' / ® No Iowa Criminal History Record found with DCC - Iowa Criminal History Record attached, DCI # 'A'A 4 �y DCI initials_TAC-- L4YrI (VO/FJ/IVl Received Time .Ian 11 9hl� ll,nneM hl„ )Ful Feb. 3. 2017 3:44PM Div of Criminal Investigation No,Mio DCI:00441486 NAME: KAIM, DAN KAIM,DANIEL P XAIM,NIKITA ANDRBI DOB SEX RAC 19731118 M W ADDITIONAL IDENTIFIERS TAT LF ARM IOWA CRIMINAL HISTORY NON CONVICTION DCI 00441486 PAGE 1 OF 1 DATE PRINTED - 2017/02/03 HGT WGT EYE HAIR 5104 POB 507 201 BLU BRO PAR FL CCH RECORD *** 01 ARRESTED/TAXEN INTO CUSTODY 19991024 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708-1/236-2 DOMESTIC ASSAULT W/INJURY TRK#: 035763401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: TA708.2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING CHARGE CLASS: NON CONVICTION TRK#: 035763401 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20000218 COURT COSTS 20000218 PROBATION lY 20000218 DISCHARGED FROM 20000918 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 DCS. 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