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HomeMy WebLinkAbout17-098� r t CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. 1 :1 — 0b (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: 4a. Driver's License expiration date (REQUIRED) 09/ b. Taxicab Business Name (REQUIRED) /elk y 5. Prior experience in transportation of passengers: b 1[} S2-1 1S �-11 (VA Cell Phone: (aLj?) 7y4- oq sent via 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? p o 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? 7`c TypeOr offense Where When kWdHS Uo l�}�i�rs [a,f7 l��E/Zo12 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ea�five Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the aars? =Vo Type of offense Where : en c 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please p the namEV GNU/ �IAATT 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 here B eIrRf I that I have issued to me by the Iowa Department of Transportation at valid Driver's license number issued on 10/01 DMexoirina nn ('X/l ) /2.131 I Ilnriarctand 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 Tige 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant vvl*U+y11y� Dateyg/a/Zat7 STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by _,, ` c �� �. a� . �, , vsov\ -on this L 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 th Ck of Iowa City (Title 5, Chapter 2, City Code). license or designee —'D 12 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. Signature of City C c or designee /) R -a -l7 Date N 0 Office Use Only Approved application c7� ro r DCI report State certified driving record Website update —In tit 1> _ Clerk/TMIDRN DGE WL92014amendWDOC 07/2016 ARTS Page 1 of 2 11 . i U44ADOT SMARTER I SIMPLER I CUSTOMER DRIVEN VVWW'IOWadot.�OV Inquiry 8/1/2017 Date: Customer 5262228 Name: Anderson, Michael Anthony II Address: 1021 GROVE ST APT 1 City/State: CEDAR FALLS, IA 506133365 Mailing 1021 GROVE ST APT 1 Address: Mailing CEDAR FALLS, IA City/State: 506133365 Date of 8/17/1987 Birth: Sex: M Convictions Office of Driver Services PO Box 9204 1 Des Moines, W 50306-9204 Phone: 515-244-9124 18011-532-11211 Fax: 515-239-1837 www_iowadot-gov Certified Abstract of Driving Record DL/ID #: 278AD6643 (IA) CDL Permit Class: None Class: C Audit #: 7391746 Issue Date: 10/01/2013 Expiration 08/17/2018 Date: None Endorsements: NONE Restrictions: Corrective Lenses Restriction None Supplement: CIA History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: t.___ 12/16/2012 CDL Permit None Restrictions: jDes Moines ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: t.___ 12/16/2012 CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation JUR County t.___ 12/16/2012 592 ed ._19/2012 iIA jDes Moines 11/19/2012 12/16/2012 B64 tpeInsurance Card CIA jDes Moines 08/27/2016'i09/13/2016 IS92 ed SSD Name: Anderson, Michael Anthony II DL/ID: 278AD6643 (IA) 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: VEt11C!! N", >o,�p@• • ,ljdi��4 8/1/2017 soe'ter IOWA':y'6 :o, -q,�e� oe r' 14nf; .......... :may\` http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 8/1/2017 o71Jul.21. 20111; 4:45PMCab Div of Criminal Investigation (FAX)3193362N0.5991 P. 1/11002 BTA Criminal H To; )'owe DIVI91011 a(Criminal Investigation Support Oporatlons Bureau, I" Floor, 116 )3.7i6 Street DasMolnee,Iowa 60319 ----(fiItM&a66 (SIB) 721-50g0 Fox OF IOWA ry Record Check ,sf Form r;noi. DCI AaaountNumbor: ,_,9907 -JF (IreppilWbl��� From: Yellow Cab of Iowa Clty P.O. Box 428 Iowa City, IA. 52244 (919)388-9777 Phonal Fax, (319) 339-7302 •"m .� w�swn �.. nom..-wu..••m. u....-. Last Name menduo .�--.-�..__.. Vint Name -... radeto Middle Name two,n set ArJp(r.�svtJ '/, iso .e Data of Hirth m,ndet ) Gender (mendbiw A Socialaour! Number commcrAcd) C76/) 7 A -7 la ©FemRla 331- $ y , sz Waiver Informadan: Without a signed waiver from Iho sebleol of the request, a complete eriminal history retard may not be raloneable per Code of Io1va, Chapter 692.4. For cnmole(ecriminal history record Informatlom, at allowed by low, always obtatnawaverplanes urofromthe subject orthern uest. Waiver Be%ase:l henby f6lys peenlaloo for the ebovo nquatin l amtid ro conduct an lo+vs edmf,w ldaoryreeotd checicvvhh the Dlvlflen etComfoel inwaddetien(DLi). Myotlmlmlhhmryduseenoemlmmeoil it -a-lhltdn/cdb/ythvAClmgvboreteueamAloweabylaw. _ _-..—Wa1V6r:if8Naf7fret ' N' .�,�^/ - ..... __. I As of -:-1- 1�_,a.searchofthepr No Iowa Crimhwl History Record IJ Iowa Criminal History Record aitt DCT DCI.77 (08/25/10) Received Time Ju1.11. 2017 9:23AM No.2914 mune and date ofbirih reveslcd: with DCI DCT# _.._— (DC1 me on117 ,