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Home My WebLink About17-0511 ► t t � ayyl®i�11 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. (Office Use On y) 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: ')tipr _ � U Q 4 a �ao . Cv+ - Cell Phone: 31 (All�tten communidaikkin sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted DismissedDeferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? � 1 s Where What happened to the charge? (Circle one) When Convicted Dismissed Deferred Suspended Plead GuiAy) Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /ye Tvce 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) Li 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{fornv 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 j U�✓ui5V,z issued on 3- / - / `/ expiring on 2 -? C - / 9 . 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 7 13 HMMffffl'ff'lfil'Ff11HM1fHH1fM1MfHf11f 111ff/r1f f 1f f f f ff f f f f f 1ff 11fHfHfffllf 111Mff1fM1fRf111fH1111f1f11f 1f ff f 111111 11fHHf1f fflHflH STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me byjq F+ I� \ . 1� L, Q i on this _� day of Notary Public in nd for the State q Iowa Nwro« ntwse 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). 2�Z�ll� r �Zlj/ /I Date OVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO ONE YEAR FROM THE DATE LISTED BELOW. _4N/7 17 itv Clerk or desi. nee I Elate 1H1H111fYlIf•FH1f4tfflf 1f fHH11HHf-f1HHtiffff}1f1111111f111f f1HHH1H1Ht11f'H.111f1f1f 11HH1Ht11f 111tfYFIf1f11f} Iff11111111f1ff11111H Office Use Only Approved application �81 LM DCI report State certified driving record t Website update OerWrA%IDRN ADGEAPPL9201dame dtl DOC 07/2016 C Iowa Department of Transportation Me d Drnrer Services (rdt Ffee) 8DD-532-1121 PO Rat 9204, [les Manes, IA 50306-9201 515-244-9124 FAX 515-239-1837 Convictions Citation Date Convletion Date Certified Abstract of Driving Record Mcplanation Inquiry Date: 3/27/2017 DL/ID #: 350WW1842 (IA) Customer #: 1209464 Name: Kuiper, Jeff Michael Class: D ID Status: None Address: 2662 BLAZING Audit #: 7839378 OL Status: VAL STAR DR Issue Date: 03/01/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/26/2019 CDL Cert Status: None 522406848 Endorsements: 3 CDL Med Status: None Mailing Address: 2662 BLAZING Restrictions: Corrective Lenses Restriction None STAR DR Supplement: Date of Birth: 2/26/1975 Mailing IOWA CITY, IA Sex: M City/State: 522406848 History Information Convictions Citation Date Convletion Date ACD Mcplanation Coun JUR 02 21 2017 103/23/2017 S92 Seed lHenry IA 11 Name: Kuiper, Jeff Michael DL/ID: 350WW1842 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: 3/27/2017 IOWA ' + D. 0. T. yy Office of Driver Services . Iowa Department of Uankporation Name: Kuiper, Jeff Michael DL/ID: 350WW1842 Ma r. Z/, M/ 1U:11AM Uiv of Criminal Investigation 09/24/2017 12:61 M FAX 9199997902 03lhal•14. 1 17412:45PM Cab Div,of Criminal Investigation +"STATE OR IOWA lCriminal IfistoryRecord av!1�,� 1!•'Request Form Tal lown Dlvtslon orcrlmrnol Investigation 9upppert Opera lonr>3ureauI)"'Floor 21S!`, 7 Streol Dos Molna, rows 60319 151 S179119... e No. 6608 (rA)031833ez•N o . 6501 P. 1/6 wi uuut/0002 P', .302/002 DC7 Account NumbOr: `9967-F (I1tipslIvAbiq imam) Yellow Cab ofXowt CI RO, ah 428 lows c FfYi XA, 52244 Phone: — Fox: (31 ) 33 r. 302 —/ - --,. ••��f�e+er rrwmmenea -2 --2G- ,. ItdMale ❑ramale t� Walverlrljormatlon wlene IIn / LIZ 3 �y -• - 4par I rfmrar ItOtn the JabI00I dl r Ob rdealable, par Code of Iowa, e'jtub r 692.2 For co ate h0 I(b?Y.r t, o 0 Infra to Oriminel history record tpay not obleln o wMversl natvra ham Iheiub �—criminal history r4cerd Infermaslan, Al allowed bylaw, olwAys o0c ohh0 ro u0s1 ii/glver Rllease; I helebyplve pamllutOn sor Ina ebeve fe4vesllet OM B101 le aondvvl en )ewe 4rtldleal InvudOedon (DC¢ Mr alminu Mgary aen eshoemlet Me *11 ff Me1Alllned by the Cal mey be fek"ed bs elllowfa by lew, eels with IM DIdtlon orCrlmind tx'alusrS/gnolurcl_��Q�__''--� ' '• I vie only) As of 3 1 1 a search oithe provided h0n10 and dale of birth rovealed: ❑ No IOWA Criminal History Record 1bwld whir DCI ~' )owe Criminal HlBtory Record altaohed, DCf !I to`�' 'x'45 � '� - ' `.' DCI Wtleia �} f DCT -77 (08/23/) 0) RRcte•ivedTTime�aNlar�24�Q2017� 1 5.2PMeNo:6§05. • Mar. 21. 2011 10:23AM Vv of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00683845 NON CONVICTION PAGE 1 OF 2 DATE PRINTED - 2017/03/27 DCI:00683845 NAME: KUIPER,JBFF MICHAEL DOB SEK RAC MGT WGT EYE HAIR SKN POE 19750226 M W 511 140 BLU BRO MI ADDITIONAL IDENTIFIERS TAT BACK CCH RECORD *** 01 ARRSSTSD/TAKEN INTO CUSTODY 20021025 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401(5) POSSESSION OF CONTROLLED SUBSTANCE I TRK#: 100698201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRO63709 CHARGE CLASS: NON CONVICTION TRK#: 100698201 SENTENCE DEFERRED JUDGEMENT PROBATION 1Y COMMUNITY SERVICE 25H DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20050119 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESSION OF SCHEDULE I 2ND OFFENSE TRK#: 101406601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR071188 CHARGE CLASS: NON CONVICTION TRK#: 101406601 SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY DROP REGULAR UA'S DISCHARGED FROM DEFERRED JUDGEMENT DISP EFF DAT 20030304 20030304 26030304 20040818 No.6608 P. 2/6 DISP EFF DAT 20050708 20050708 ,a %'V LIN 20060731;, U : ) '7'd� i Ci Mar.27. 2017 10:23AM Div of Criminal Investigation DCI 00683845 PAGE 2 OF 2 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 DCI. 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 No -6608 P. 3/6