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Home My WebLink About17-050st �III�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX IDENTIFICATION NO. i7 , 0 rU (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 F'rst 1. Name (REQUIRED) C- Ir I S 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: (All written commu 4a. Driver's License expiration date (REQUIRED) q— Zti- b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: iddle 1�A L1 Cell Phone: 3(Q' nicatio sent via email) Z023 ; reiirx� �4�J w ti 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?y 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? YC 5` Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Ejead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? iJ 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 certi t I ave issued to me by the Iowa Department of Transportation a valid Driver's license number �6Q � 4, issued on 3-1`6-7,ok expiring on `1-Zy-20Z3. 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, gpd pl further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of T!W5,,Chapter 2, o t C' ode. (Needs to be signed in front of a Notary Public) Signature of Applicant Date -31-17 , 0 � J Y+++++YM4#***x**xxx*M*xx*#!#*#xx****xx*M***lxxx**x!!#xMx!llxxMlMx!lMlxmlMYMM44+4441Y44Mi+4+Y+M++#:F+*M#**##Y+***x***!*Y*xMxlMlM! STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by�c&C irJOh this day of 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, CCiiitty Code). Expiration date of Driver's license 1 Signatureoliordesignee WW2 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. L, 3/ / Signature of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record Website update aeMRN(IDRIVBADGEAPPLg2014am ded.DOC 0712016 C410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.goV Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800.532-1121 I Fax: 515-239-1837 wwwJawadot.gov Certified Abstract of Driving Record Inquiry Date: 3/31/2017 DL/ID #: 769YY1758 (IA) Customer #: 1272105 Class: D Name: Lottich, Christopher John Audit #: 8934357 Address: 1463 WESTVIEW DR Issue Date: 03/18/2015 Expiration Date: 04/24/2023 City/State: CORALVILLE, IA 522411031 Endorsements: 3 Mailing 1463 WESTVIEW DR Restrictions: NONE Address: Restriction None Mailing CORALVILLE, IA 522411031 Supplement: City/State: Date of Birth: 4/24/1979 Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: ACD CDL Permit None Endorsements: Suspended CDL Permit None Restrictions: Non -Payment of Iowa Fine ID Status: EXP OL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Ration Date Conviction Date ALD Explanation County JUR 61191201607/07/2016 M14 jFail [o Obey Traffic Sign/Signal Johnsan jIA Accidents - Accident Involvement indicated does NOT mean the Individual was at fault or given a citation. kccident Date Case Number �JUR 12/22/2008 480109+A Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 02/13/2009 03/15/2012 D53 Non -Payment of Iowa Fine IA IIA Suspended 03/04/2009 12/21/2009 lb38 jFail to Post Security for an Act IIA Suspended 06/02/2009 03/15/2012 ID53 INon-Payment of Iowa Fine IIA IIA Name: Lottich, Christopher John DL/ID: 769YY1758 Pursuant to Iowa Code 4321.10, 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: pFIICif "^�y 3/31/2017 ¢' IOWA'tr y°.D. 0. T.;rP'tta°'J� A� •. ihyBf•�r Office of Driver Services ��,..- Iowa Department of Transportation Ma r. 23. 2011 2;21PM Div of Criminal Investigation No. 6401 N. 2/2 �.,y Caler,c vniau uin Sa oe,ua, 03/22/2017 13:15 41661 P.001/001 STATE OF IOWA Criminal History Record Cheep Request Farm DCI Account Number: Y() 0 '�=F (if appiicahle) To: Iowa Division of Criminal Investigation From: Ct of Iowa city SuPpand erationsAureau> I" Floor City Clerk's Of ee "- — 2151?. 71h Street 410 C. Washington Street Des Moines, Iowa 50319 l515,j 7Z5.60(srs �awi G 52240— (515) 725-6090 Fax - --- Phone: 319.356-5041 Fax: 319-356.8497 I aln fe0pe5tino, An IOWA (.rhslinnI incl... RnenrA La/st i"i8fine (mandatory) First Narne (mandatory) Middle Name (moonuoended) (-0f'll�.� cl�b��57�1�I1C�r rJo�V\1 Date of Birth (mandslory) Gender (mandatory) Social Security Numbecr�(reeomcm�cnded) GI a ~ ` I ®Ma[e Female / Ll I - () V - I (� y C� Waiver Xnjarrrtation; Without a signed waiver from the subject of the request, a complete criminal 111story record may not be releasable, per Code of lows, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signs ture from the snb'ect of the request. Waiver Release: t hereby give pemlission for the above requesting official to conduct an Iowa crtminal history record cheek with IAe Division of Criminal Inveeligatlon(DCI). Any criminal history data concerning nm that is maintains eDClmayberelearedasallo,vedbylaw. Waiver&gnontre: S ~�- Iowa Criminal History Record Check results -- (DCI use only) As of a search of the provided name and date of birth revealed; t•a .' XL�No Iowa Criminal History Record found with I)CI Iowa Criminal History Record attached, DCI # r_ DCI initialsoz,..- DCI -77 (08/25/10) Received Time Mar.22. 2017 12:54PM No.5862