The URL can be used to link to this page

Home My WebLink About17-073• 1 r I CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. (Office LJse 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) 4a. Driver's License expiration date (REQI b. Taxicab Business Name (REQUIRED) Cell Phone: sent via email) 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? AJO 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? A)() Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Nd 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 ty that I have issued to me by the Iowa De a ent of Transportation a v lid Driver's license number �l�¢�ed9t2 issued on�' expiring on ! o o 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 provisionsJ��,�atie�ter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant= /�J� " Date �'A,� - 1 »»++r++r+rr+rr»•rr+rrrrrrr»»+:rrr»rrr»»r+r++r++++++»a+e+rrrr++rre+rrrr»rr»rrrr+r:r»»rrr»+++a»»»r++++»+»+r++r+»rr+rrrrr++rrrr STATE OF IOWA ) COUNTY OF JOHNSON ) scribed and sworn to before me by I r �a F - I COC 1 on this 1 "� day of I s""'p KELLIE K. FRUEHII L �"i610n M!"'��?t ublic in and ort tate of Iowa +.+..+rr+»..... ..++ 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 to of Dp4 s licen !]�/�6117 r 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. Si r of City Clete r� rk or designee Date »»»»»»rr•rrrr»rr»»r»»r»r»rr»»»r»»rr+rr»r»»r»rrrr+rrr»r+»rr»r»»+rr+»+»+»rrrrr::r»»»rmrr:++rr++»r»r+a++++r»a Office Use Only Approved application DCI report State certified driving record Website update Clerk/rAXIDRIVB.4DGEAPPL92014ame dO DOC 07/2016 CmJ10WA00T www,iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: Address: 5/5/2017 6265485 Page 1 of 2 Office of Driver Services PO Box 9204 i Des Maines, IA 50306-9204 Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837 wwwJowadotgov Certified Abstract of Driving Record DL/ID #: 989AM2982 (IA) CDL Permit Class: None Class: C Georgi, Michael Vincent Audit #: 9892982 507 W STH ST Issue Date: 03/29/2016 City/State: MUSCATINE, IA Expiration 12/20/2021 Date: Endorsements: NONE Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit 527613209 Mailing 507 W 5TH ST Address: None Mailing MUSCATINE, IA City/State: 527613209 Date of 12/20/1977 Birth: None Sex: M Expiration 12/20/2021 Date: Endorsements: NONE Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: CDL Permit None Restrictions: Iowa Department. of Transportation ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 08/19/2014 813121 IA Name: Georgi, Michael Vincent DL/ID: 989AM2982 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: ;.......:; Up 4r 5/5/2017 *, D. 0. T.:p' 0?1e;�" 1YW fQ�ry� Office of Driver Services LMS Iowa Department. of Transportation 5/5/2017 May. 10. 2017. 2:57PM Div of Criminal Investigation OS/C,.,..<.J3....vn Cab 6i .... ..,y U (FAX)31933927 N.P. 9046 P; . 533/00'3 0 STATE OF IOWA f t Criminal History Record Check Request'Form �Y•spR . t To: Town Division of Crlmlual Iaventlgation Support Operations Bureau, V Floor 218 E. 74 Street Des Moines, Iowa 90319 F nm renti6dina nn rmva rlriminnl VlnfnN Rwnnrvt C6enb n... DCI AocountNumber: 99¢7-F (troypllcabh) From; Yellow Cab of Iowa Clty P.O. Box 429 Iowa City, IA. 52244 (319)331)-Y777 Phone.• Fox; (319) 339-7302 Loat Nam (mMdelc First Natlfe tmead wry) i4lid le Name t ommonded) 1 nil, Date of Hirth mbdala Gendermendaa Social .Number (reeommeade �3��' �cI�J� ❑Female yySecurity ��l� ~ �/ ��q l�fiVtale WalperInjbrmatlon: Without a signed welver from the subject of the requett, a domplete criminal history "Gard maynot be releasable, per Code of town, Chapter 69x.2, For ppcrlminal history record Inrormutlon, at allowed by-law, always obtain a waiver el naturefrom•thesubectofthere uest, WalverRelease;)hctsby61yeFamdataatbtthsabova e o c toUnduetaalolvAidWnslblaotyieaardcheck wi,hthe DiYwonorcriminnl Mcilimlon(DCI). Any mlminalhitwryditaconctmingm m the 0 benleuedaselloWedbylow. Walver 51gnahlre; iown urimima1.nistory icecora u"neex 1Cesultis(DOJ uea only) Aa of 5 /O a search of tho pmvlded name and dote of Wilt revealed:' No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI.# .i DCI In(tials-� DCI -77 (08/25/10) Received Time May, 5. 2017 12:44PM No. 8674