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Home My WebLink About17-091lr CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa S2240-1826 (319) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB I 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 Middle a M Q.S LasO 2. Address (REQUIRED) 3a5,5 HcL,sfl hGS V 3. Contact Information (REQUIRED) Email: RJL !I fliia q _ c 6 L— Cell Phone: (All written communis tion sent via email) 4a. Driver's License expiration date (REQUIRED) % – 8— AS - b. Taxicab Business Name (REQUIRED) M a ( tC>,S*DO( 5. Prior experience in transportation of passengers: ZA tw.fe h CO 6n ER rS a S U L cL-6 Pl a<c e's -1 Ayl S v aca tS 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? h 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? Type of offense Where W heD> 0 What happened to the charge? (Circle one) n'< C4 1- in Convicted Dismissed Deferred Suspended Plead Guiltg<RthV 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five -.A O �✓ Tvoe of offense Where 'khen rn 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 certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number tin /i C0 l55 issued on r7-7-17 expiring on 7-9- aS . 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 ��i — Date -7-13 - ) `% STATE OF IOWA ) COUNTY OF JOHNSON ) S'LIr ed andworn to I. before me by o "'� KELLIE K. FRUEHLING Commission x L Number 721819 oe L11,44Sa. wagfrthis of Iowa 1��' 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 the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license 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. Signature of City Clerk o designee � Date Office Use Only o_ CS Approved application D� DCI report r �- State certified driving record :4c-3 Website update ;Em o:v _ D cR a+ Gert✓rA%IDRNBADGEAPPL92014a.ded.DOC 07/2016 SMARTER I SIMPLER I CUSTOMER DRIVEN vimmiowadot.gov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-92D4 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry 7/7/2017 DL/ID #: 126AC6155 (IA) CDL Permit Class: None Date: Customer 2108144 Class: D CDL Permit Issue None #: Date: Name: Liittschwager, Robert Audit #: 1945395 CDL Permit None James Expiration Date: Address: 3255 HASTINGS AVE Issue Date: 07/07/2017 CDL Permit None Endorsements: Expiration 07/08/2025 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: None 522454022 Mailing 3255 HASTINGS AVE Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522454022 Status: Date of 7/8/1962 CDL Cert Status: Non -Excepted Intrastate 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. Accident Date Case Number JUR 08/30/2014 814875 IA Name: Liittschwager, Robert James DL/ID: 126AC0155 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: Name: Liittschwager, Robert James DL/ID: 126AC015S 7/7/2017 IOWA 0 lyw�oe& o e f '••••"$ Office of Driver Services 'n�B Iowa Department of Transportation Name: Liittschwager, Robert James DL/ID: 126AC015S 07LJVl_IV. LU 114 y�30Hlvl Ulv 0 <.YlminaI investigation - ,DCI T011'ho'HyLI r.. i STATE,'OF IOWA Criminal History Record Check f Request Form FAX DCi Account Ntmrber: (Itapplleahle) To: Iowa Division nrCriminal Investigation Frain; City of lows City _ Support Operations Bureau, l" Floor City Clerlc's Office 215 E. ?" Street 410 L Washington Sino( Des Maines, Iowa 50319 (515) 725-6066 Iowa City, IA 52240 (,515) 725.6000 Fax Pboner 319-356.5041 Fax; 319-356-5497 r-.- 1 a,n rptimMina rn Inwa rviminnl 14istnry Reenrd Check not Last Name (inaddarory) First Name ntcl,datery) _ Middle Name (recommended) LMtsAvt0Joer Rots T+ �a►w� Date of Birth mandato Gendor (mandato ) Social Security Number (rcam,mcndcd) .......-7w1.� �3h I�'Lo�i Male ❑Female 484-'7-�3y�O Waiver In orinaljDn; Without a signed waiver flrom the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For camnlete criminal history record Inforalationt as allowed bylaw, always obtain a waiver signature from the subject of the reguest. Waiver A61eaS9; I hereby give permission he the above regnesang official to conduct an low. arlminal history record ehack with Ole Division ofCriminal Inveeligotien(DC). Any criminal pinery dote eancering me that is malnlelned by Ilia DCl maybe released as alloaved bylaw. Waiver Signature: Iowa Criminal History Record Check Results (D(0leaaonly) 1-1 As of 0_� i� , a search of the provided name and date of birth rovealod( No Iowa Criminal History Record round with DCI ❑ Iowa Criminal History Record attached, DCI # r' DCI initials DCI -77 (06/25/10) Received Time Jul, 5, 2017 10:46AM No -2426