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Home My WebLink About17-143• � l f CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED, IDENTIFICATION NO. 1 — P-0 (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 avolication 3. Contact Information (REQUIRED) Email: YE1-toWct :c—(P4g!n L, COyN Cell Phone: JAI 1 ' SNJ'd5�3 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) //3 1/eRp I b. Taxicab Business Name (REQUIRED) ��ELLbt✓ C/i73 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? / a 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? N/2 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? /t/ O Type of offense Where When 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 CERTfPIED ~1 DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF R VIEW— You must apply for an individual Department of Criminal Investigation Report (form avalloble upon re"t). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) '7) Jl 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa D pa ent of Transportati n valid Driver's license number 435t=yO2s issued on a?? l3 expiring on '7 L41111 . I understand that if I falsely answer any questions in this application, that this app ication 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 provision le 51 Ch MOW 2, of the City Code. (Needs to be signed in front of a Notary Public) � O Signature of Applicant z< Date l a HHHNfl4YlHfHf!!f 1HHlHl4H44Y4Y}4HH11fl1fllf 11f 4lfHHfif 11f f4f!lfYl4f IrYHHH}!fflfNHl4fYli}H}1H1fllIf{{}}ff}f111f1fHHHH}ff-If STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed -7n kworn to before me by 12�� f�c�t e.�_ on this 1Z 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 p'7 I3 ( I.2 06K -1 ILU Sign re of Police hief or designee IL'a 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 or de6r9nee U Dat Nf1NNHH1HfX1HHHHlNf4ffY1f Y {f}flffHlHNf 1141! 111H}M11f 1f411flN1NNfifliflH}HlHNfNNNfNfffflt/r1Jt 1t4i4N1fHfHfHNNfNff -J Office Use Only o —� Approved application c'> N DCI report :f 71 State certified driving record "o —7 Website update cn cwkrtAww+NanocEnaaLyzoieamwaea.00c 07/2016 STATE OF IOWA 0 Criminal History Record Check Request Form. To: Iowa Division of Criminal Investigation Support Operarlons Bureau, I" Floor 215 E.7" Street Des Moines, Iowa 50319 (515)725-6066 J'qfeAD 051 (FAX)3193382708 P.003/003 ,,0 0,towW3. DCI Account Number: 9967-F ^— (Irappllcable) From: Yellow Cab of Iowa City P -O. Bos 42B Iowa City, IA, 52244 Phone: Paz: (319)339-7302 Male . ❑Female CLt-zo-r Vg (- 9c� -> ep 7.5 - Waiver Information. Without a signed waiver from the subject of the request, A domplete criminal history record maynot be releasable, per Cotta of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed bylaw, always Obtain a waiver signature from the subject orthe request Waiver n PCI). Any hereby give permission lot Ne above mquestln9 otliolal to conduct M lows criminal history =cord chock with the Dlvislon otcrimirml Investigation (DCI), My crlminat history data concern' a that is 'seined by tho DCI maybe released as allowed by law Waiver Signature: �� — — Iowa Criminal History Record:an sults (DCI use only) As of C� a search of the provided e of birth revealed: No Iowa Criminal History Record found J�a:'.e CD .'.�Iowa Criminal History Record attached, A + '1„ DCT initials DCI -77 (08/25/10) 1 Rtctivtd Tim: SPP, 25. 2017 9:56AM No, 7353 AC Iowa Department of Transportation OfAce of Dni Services (Toll Reel 80G W 1121 PO Box 9204, Des Maines, IA 50306-9 44 204 515-2-9124 FAX: 515239-1837 Certified Abstract of Driving Record Inquiry Date: 9/25/2017 DL/ID #: 435ZZ1025(IA) Customer #: 2308987 Name: Bradley, Roger Elliot Class: D ID Status: None Address: 2327 E COURT ST Audit #: 7383317 DL Status: VAL T Issue Date: 09/27/2013 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 07/31/2018 CDL Cert Status: None 522455218 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 2327 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 07/31/1965 Mailing IOWA CITY, IA Sex: M City/State: 522455218 History Information CLEAR DRIVING RECORD Name: Bradley, Roger Elliot DL/ID: 435ZZ1025 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: IOWA D. 0. T. Name: Bradley, Roger Elliot DL/ID: 435ZZ1025 9/25/2017 Office of Driver Services Iowa Department of Transporatior C) C) t 9 - C7 T rJi