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Home My WebLink About17-081r t IDENTIFICATION NO. 1-7 — 1 l t (Office UseOnly) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER C ITY OF IOWA C ITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington Street Iowa City, Iowa S2240-1826 Failure to complete the `required" information will result in denial of the application (319) 356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) � o_ c1 �� CG-�j( IVIA I Lit d 2. Address (REQUIRED) 'TFC gt�M) 5 2z M r 3. Contact Information (REQUIRED) Email: /1i ayk conCell Phone: 515 LlCo0-aJ F?K (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) /(A I Z 1 ZC Zq b. Taxicab Business Name (REQUIRED) gRpL-Q ed I 5. Prior experience in transportation of passengers: 1 1 i 116t'—MCi1Df e0ar k- SC-{ lCA h , 91 Have you ever been arrested / charged with any misdemeanors and/or felonies in this Stale-or@Isesohere=0 0 Type of offense Where . - en M What happened to the charge? (Circle one) CA 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 Fcw ( f o Where When What ha aneAt vwe hang vrZ,,,.�- At lc—V-66� % 12. ILA peened to the charge? (Circle one (wZns�,vcw�a.Ccs4 \—�--•'� Convicted Dismissed Deferred Suspended Plead Guil Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to bean 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 �3-� WW`4`t00 issued on JccK 3/, 17 expiring on ZOIILI&)ZY . 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, ChapI City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date D STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 3ltr.�n �. 5�pyfwl=�j_ on this day of I" - r i—I 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 CLe.� Signature o P ice Chief or esignee lo- )a- A# S -3o -/;L 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 of City Clerk oro nee —T\Dae N Office Use Only - tc o r Approved application` x !V 0 DCI report n AI State certified driving record C Website update aerk/TAXIDRNBADGP PPL92014amended.DOC 07/2016 ( 'F� �.�.. —. �s —. .�Y- c'—i•s CI B(.. '.r.i.— --- ..-- �-- i6ar ivn Ofi /09/2019 1B.fIY V. VU97 BBi:.r�U/U2/002 STATE ATF IOWA GO, Request Fobs DCl Account Number: 4O0 2 nn vY appuwotolM To: luwa Division of Criminal Investigation From; City of Iowa Ci Support Operations Bureau, I" Floor— •_--------- City Clerics Office Des $, 7n' sn eat 410 E. tr Ainuton street Des Mohres, Iowa 503I9—'---�—`--.—.__— (515) 725-6066 _ Iowa City. IA 52Ed0 9 ax - an IoNva DCA- I2 , l 1i Lo , Pllolic: 319-356-5041 Fax: 319-356-5497 —� re, ir—A, a UMale Female �Q't waiver La/orffteliOla: Without a signed waiver from the subject of the request, a complete criminal bis(ory record may not be releasable, per Code of Iowa, Chapter 692.2, For complete criminal history record Inform atlon, as allowed by Inn', always obtain 8. Waiver signoture from the 6rrhiaet nr th. rwno.�Y IFaiver Re%aSe: I hcteby give pertnlssion for the above requesting official to conduct an tows criminal hinory record check widuhe Division ofCriminal Investigalian(DC), Any criminal history date ommerningme lhatis maintained by the DCl may bereleased as allowed by law, Waiver Sigilnfure: As of a search of the provided name and date of birth revealed: Y1\10 Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCT # DCI initials_ DCI -77 (08/25/10) ~� Received Time May, 9. 2017 4:01PM No, 8942 C Iowa department of Transportation Office of Omer SeMccs Boll Face) 000-532.1121 PO Bax R204, Coss Maims. IA 51130&9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/9/2017 DL/ID #: Name: Schmalzried, Class: 1580130 Brenda Kay VAL Address: 3620 HIGHWAY 1 Audit #: 10/12/2024 SW Non -Excepted 319 339-3921 Medical Examiner Type Issue Date: City/State: IOWA CITY, IA Expiration Date: Corrective Lenses, 522408595 None No Class A Supplement: Endorsements: Mailing Address: 3620 Highway 1 SW Restrictions: Date of Birth: Mailing Iowa City, IA 52240 Sex: City/State: CDL Medical Examiner's Certificate 337WW9900 (IA) Customer #: 342967 B ID Status: None 1580130 DL Status: VAL 01/31/2017 CDL Status: VAL 10/12/2024 CDL Cert Status: Non -Excepted 319 339-3921 Medical Examiner Type Interstate PS CDL Med Status: Certified Corrective Lenses, Restriction None No Class A Supplement: Passenger Vehicle 10/12/1968 F Certificate Specifics Explanations Medical Examiner Flrst Name Daniel Medical Examiner Middle Name Albert Medical Examiner Last Name Hogan Medical Examiner License Number 21104 Medical Examiner National Registry Number 4744214919 Medical Examiner Jurisdiction IA Medical Examiner Phone 319 339-3921 Medical Examiner Type Medical Doctor Medical Certificate Restriction 1 Wearing corrective lenses Medical Certificate Issued Date 01/31/2017 Medical Certificate Expiration Date 01/31/2019 Date Added to CDLIS Driving Record 01/3112017 History Information Convictions Citation Date Conviction Date ACD Explanation lCounty JUR 10111512014 102/12/2014 B64 No Insurance Card Allamakee IA 07/02/2014 07/15/2014 D72 Fail to Have Vehicle Warren IA 01/15/2009 486279 IA Under Control 806257 IA 01/26/2015 02/23/2015 M14 Fail to Obey Traffic Johnson IA Sign/Signal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/23/2008 422201 IA 01/15/2009 486279 IA 07102/2014 806257 IA 01/26/2015 842074 IA Name: Schmalzried, Brenda Kay DL/ID: 337WW9900 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; IillIIRE *Nttl 5/9/2017 ILI Office of Driver Services Iowa Department of Transporation Name: Schmalzried, Brenda Kay DL/ID: 337WW9900