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Home My WebLink About17-106 IDENTIFICATION NO. f 7-10& I — 1 !(Office Use Only) 42141 14. CITY OF IOWA CITY APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER (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 (319) 356-5040 (319) 356-5497 FAX First $0,62. Middle �1K Last 1. Name (REQUIRED) /u9 2. Address (REQUIRED) 2.5 r? J;o' Dv 3. Contact Information(REQUIRED) Email: /Yli'i 1-JAiw, 4333741hoemC..-Cell Phone:313.2' / ('FJ$y (All written communication se via email) 4a. Driver's License expiration date (REQUIRED) t7S e1;249 02.4 b. Taxicab Business Name(REQUIRED) ' eoth 5. Prior experience in transportation of passengers: mVL j' n yy 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? 7-4 Type of offense Where When Lat- 6!t/ss/•2.4r14 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? /444 Type of offense Where When p eil sccytt Co . l i 1ac9 ! 13 9L2d io w co_ € 15 pg-/ 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? 441 Type of offense Where When ...� a Ell GIamigoamigo 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prejthme(I) VA , = Chi DEPARTMENT OF CRIMINAL INVESTIGATION (DCI)REPORT AND STATE RTIFWD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CFIIEF 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 66)-7>il. issued on 6�47.,57/7 expiring onePr--al 2J . 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 Date STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by k . 1\-1,21-1-.i on this / day of mAl et VVENDY S.MAYER a ,:y: S Commission Number 729428 Notary Public.V and for the Stat=(f Iowa IOW �) ************************************************************************************************************************************************ 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 g/1 ( 2�� 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. :( / 8 7rsacsa Signature of City CI II or designee 2erecaNtri rn Office Use Only c� 3 ... Approved application .. DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 07/2016 • SMARTER I SIMPLER I CUSTOMER DRIVEN WWW'iOWadO .gOV Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 I 800-532-1121 I Fax:515-239-1837 www.iawadot_go v Certified Abstract of Driving Record Inquiry Date: 8/17/2017 DL/ID#: 662YY1237(IA) CDL Permit Class: None Customer#: 1895748 Class: D CDL Permit Issue Date: None Name: Nguyen,Son Minh Audit#: 1768948 CDL Permit Expiration None Date: Address: 2557 INDIGO DR Issue Date: 04/25/2017 CDL Permit Endorsements: None Expiration Date: 08/01/2021 CDL Permit Restrictions: None City/State: IOWA CITY,IA 522406824 Endorsements: Chauffeur 3 ID Status: None Mailing Address: 2557 INDIGO DR Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Mailing IOWA CITY,IA 522406824 Supplement: City/State: CDL Permit Status: ELG Date of Birth: 8/1/1966 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Data __ ACD Explanation 1_1/26/2013 '01/06/2014 592 ]uR County IA Scott - _ _ 04/05/2014 —" 05/06/2014 1592 Speed(10 mph h under in 35-55 mph zone) IA Johnson • Name:Nguyen,Son Minh OL/ID:662YY1237(IA) Pursuant to Iowa Code§321.10,I,Melissa Spiegel, Director of Office of Driver Sers*s 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: iENIC[f 0' Ili •** ii 8/17/2017 ~ IOWA',S.',, 8/17/2017 D. 0. T.: 1 ,�:i(cas"J ,� 't,6.:•• • il4hvh at$�� IowaDepartment of Driver eoflces Transportation L •...( G-) oe„ew Name:Nguyen,Son Minh DL/ID:662YY1237(IA) "(""4( CO Aug. 17. 2017 9: 20AM Div of Criminal Investigation No. 8393 P. 3/3 - From:City or lowek City Clark Office 219 3666407 06/'1!5/20'17 1O:�ats 017e ,,,,,,2/002 • aryirmri STATEAE Ob' IOWA � ti ie. :4 �iti, , , ra �Fe � History e slrCheck ti,,,#,,,,,.,,,,,,.., Requeat Form 4-sr Fr" iI or DCI Account Number: (/Dr) 7,-- (if nppltcablc) To: Iowa Division of Criminal investigation From: City of fotva City ___ ___ _ Support Operations Burton, 1°.Floor City Clerk's Office 215 E. 71"Street 4L0 E.Washington Street _� Des Moines,Iowa 50319 (315)7254080 Fax • Norio; 319-356-5041 Fax: 3I9-356-5497 1 am requesting an Iowa Criminal Histone Record Check on: Last Name (mandator-) First Name nnendatory) Middle Name(reconunended) • -- /V/ tic.ye,,v. D `moi /frt. k Date of Birth (mond/story) Gender(mandatory) _ _ Social Security Number(recommended) t .r-az _fie'6stl4Male �Fc male If/ ~ 72, `�iLL • Waiver Information; Without a signed waiver from the subject of the request,a complete criminal history record may not- be releasable,per Code of Iowa, Chapter 692.2. or complete criminal history record information,as allowed by law,always obtain a waiver signature from the sub ect of the t nest. ---ii- -.,..,- - — -ffXaiver Rete rremlerc�y gigive prnnissior o1 r II a above requesliilg ofiieial to conduct an Iowa criminal history retard check ndivi hof CririffIVII investigation(DCI). Any erinwinal history data concerning me dial is maintained tie DCI may be released as allowed bylaw. , 0 t.-- ' " — Waiver Signature:_ _....",_.411.C./.•„ /i 'AI” Aar- ---------'--- -----**14._ M Iowa Criminal History Record Check Results :9( UL'1 use onl-la-- - y) ..r-> As of 8)- 1- 1 -7 , a search of the provided name and date of birth revealed: A5No Iowa Criminal History Record found with DCI 0 Iowa Criminal History Record attached, DCI# - . DCI initials I v l .. �� I ~ DCI-77 (OS/25/10) - Qcroivari TIMID And 1 9(117 10009AM No. 487A