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Home My WebLink About17-077IDENTIFICATION NO. 1 -7— Q-7 (Office Use Only) • rtltr®�� APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED)l 1 E r -i W I s r "A K I,Ll s -t) J rA 0 ti -T 2. Address (REQUIRED) V 1 ,,,l . J�Ah r't) 3. Contact Information (REQUIRED) Email: A05f-gcf PCdb,l Qvnai1,COf✓I Cell Phone: �a 1 S'I S• G 221 (All written communica ion sent via email) 4a. Driver's License expiration date (REQUIRED) 4 LA 5 A b. Taxicab Business Name (REQUIRED) N1n.1 y —, R C C C ra 2 5. Prior experience in transportation of passengers: I (-, Qs 10'A c Ali i(', v tn�% 1 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? aq Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? W Type of offense Where When What happened to the charge? (Circle one) 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? o Type of offense Where I— prm— w M 3 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provlA theqameQl 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 kPPLICATION 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 per�u s I4A(Z! n issued on '3 expiring on I i1ha . I understand that if I falsely answer any questions in this application, that this appli atio may be denied. I algreb 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 provisignkof Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant O Date STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by Irtir�l S �L�r�O on this day of Public in and forrfh@ State of Iowa fF4*f*44*******f*f,14ff*ffff**f**iff**ff**fff*f**4ff**ff*f*1f**fflfff#f*#Ik#f##4*###*#1t*f#*#4:Ffe4*##44*###444*4#4#**#***ff##f*4#fr#f*ffff*fit4iflffff 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). license I I/ 1 1 ?, 0 T� VZ/ � 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. C; natur of City Clerk or designee 5 i\v� t1 Date GerffAXIDRI 8 DGE PPL92014amende .DOC 07/2016 N ca ##*#*ff!!!!*44*****!*lflRflR!!****!!****!!***f!!!*f!!*!**!Mf!!lllfi!!!#Hf4f#4111411#44414141######44414###111�411f1f#44,14M#f*f*f1f1f1fflflff#f Office Use Only -4 -Ac Approved application =<F 3 rn DCI report 0 State certified driving record r :0: 4 Website update " — 'V GerffAXIDRI 8 DGE PPL92014amende .DOC 07/2016 04/Apr. 10. 2017o 9;50AM Cab Div of Criminal Investigation STATE OF IOW Criminal History. Recor Check Request Form To: Iowa Division of Crimlual Investisatlon Support Operations Bureau, V Floor 215 B. 71b Slroet Des Molnes, Iowa 90319 (616)729-6066 (SIS)726.6080 Fox (FAX)3193382-No. 1830 N. 11/002 DCI I oeountNumber: +r'99¢7 -F (Irnppllrsble) Fr an: Y91lowCob oflowe City P.O. Box 428 l0wa City, IA. 522d4 (319) 338.9777 'Ph Inot I?nv, (319) 339+7302 I am reoutistiniz an lowa Criminal HIM Last Name mana:o 1(eeora GrieCK an: iret Name m.ndaro' MSddIE Name (recommended) . 9D V mvnrr' IDC �-fNI S 0-14A9.LOS Date of Birth meedo Gander (rnwdmo) Wa�ukltv Number raeommendod) i l l- ��5� �1V[sle ❑Fame/ D 3 Waiver InfVrmallent Wllhout s.slgned waiver ham the subiect arthe res uesy a dam plate crlminei hlstory record may not be releasable, per code'arYown, Chapter b92.2. For commto criminal bleb y record Intoraclon; as allowed bylaw, always m obtain a w lye e re uat.. WdiverRelease:IhercbYgive permission lbrlhoabove mqueHNofficidweonduorm 1. low criminelbinowaccord checkwhhthe Division ofMrolnv Invdsllserion(DO, Any odmineihinorydawconcemin6 a aiismelalainedbytheneiA'An cicued aadlowedbylaw. Wdiver Srgrsarure; 'Iowa Criminal History Record Check Results (ocl a,e only) As of `b a searoh of the provided nama ead di ile of birth revealed. No Iowa Criminal History Record found with DCI 13 Iowa Criminal History Record attached, DCI DCI initials °�- DCI+77 (08125/10) Received Time Apr. 6. 2017 11:22AM No. 7570 Iowa Department of Transporta121 (Toll Flue) tioln Mice d DWW" Sera=515-244-9124 PO Boat 92K DM 1101011`10S.la 50'flii 9204 es, FAX: 515.239.1837 Mailing Address: 2491 HOLIDAY RD Restrictions: Mailing City/State: Date of Birth: CORALVILLE, IA Sex: 522414705 Corrective Lenses, Restriction None Left and Right Supplement: Outside Mirrors, Left Outside Mirror 11/11/1945 Q History Information CLEAR DRIVING RECORD Name: Dumont, Dennis Charles DL/ID: 445AF9612 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 f the Iowa Department an official record currently in the custody of said Office, and that I have been authorized by the Director o 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: Dumont, Dennis Charles DL/ID: 445AF9612 4/6/2017 Office of Driver Services Iowa Department of Transporation Certified Abstract of Driving Record Inquiry Date: Name: Address: City/State: 17 Dumont, Dennis Dumont, Charles 2491 HOLIDAY RD OR4 L4V�OLSE, IA 522414705 DL/ID #: Class: Audit #: Issue Date: Expiration Date: Endorsements: 445AF9612 (IA) D 1707445 03/28/2017 11/11/2020 3 customer #: ID Status: DL Status: CDL Status: CDL Cert Status: CDL Med Status: 5722274 None VAL None None None Mailing Address: 2491 HOLIDAY RD Restrictions: Mailing City/State: Date of Birth: CORALVILLE, IA Sex: 522414705 Corrective Lenses, Restriction None Left and Right Supplement: Outside Mirrors, Left Outside Mirror 11/11/1945 Q History Information CLEAR DRIVING RECORD Name: Dumont, Dennis Charles DL/ID: 445AF9612 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 f the Iowa Department an official record currently in the custody of said Office, and that I have been authorized by the Director o 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: Dumont, Dennis Charles DL/ID: 445AF9612 4/6/2017 Office of Driver Services Iowa Department of Transporation