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Home My WebLink About17-15001 -4 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-SO40 (3 19) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. I / — 15? -),— (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 application 2. Address (REQUIRED) q 1J�y��q qac Csac�ar 1�owlq t y I -A rS a-a4O 3. Contact Information (REQUIRED) Email: j0.n�� r� dtv �OII®)10{!YW it^nCell Phone: 319 59` 388(, II written'' clIommunication sent via email) 4a. Driver's License expiration date (REQUIRED) `-t - as - 7-c) ao b. Taxicab Business Name (REQUIRED) `1 s-t—WlU CR 13 0� T-4I.uA Ct7y 5. Prior experience in transportation of passengers: y(—kko (,) CA F, o � ZowA C' T- 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When hA,- itwt&amt)i— l,Jm:vYttlntrn� -7 ds 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? Type of offense Where ok,v-sc n Ca-� When Spcx cl 6 Urxph A u-wAe-tr i r,35 -S S mPti z0hL- �IDu:Ik Ci f -17 What happened to the charge? (Circle one) _ Convicted Dismissed : Deieked Suspended ead Guilty Other ` I 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ill 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) N0 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 certi that I have issued to me by the Iowa Department of Transportation a valid Driver's license number $y Y `f 0048 issued on 11-01 16 expiring on 4-1S• 2030 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 tiT Date I I- -7-OD(-7 1flf...11f.flllfl111ff1ff ff 1.1.,,..,!!11111..1flfff«11111111..f.lfllfllflfllfffff.11111111!111.8111111.fflf.if.«f!!flfl.f..1f111f«f!!!!!f!!f. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by J uKa _jS"rQ Q-- on this % day of \An C Zov 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 designeeDate 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. 7-17 ignature of City Clerk or esignee Date f Ri#1f1ff1f11N1ff1fl1111!11111H11f1H111fl111H111fHi1fMfllHllfYflYlYlfflfff�ll11111#11ff11fM1fflffff1f1H111Nfll11flf1flflfiHflM11f111f Office Use Only Approved application DCI report State certified driving record Website update Gea/rA%IDRNBADGEAPPL92010a.nde DOC 07/2016 CIowa Department of Transportation AW 016ceof Dwyer Services (Toll Free) 800-532-1121 PO Ow 9204, Des Maces, IIA 50306-9204 515-244-9124 FAX 515-239 1831 Convictions Citation Date Conviction Date Certified Abstract of Driving Record Explanation Inquiry Date: 10/30/2017 DL/ID #: 554XX0048 (IA) Customer #: 3971082 Name: Snyder, Janet Class: D ID Status: EXP Address: 9 DUNUGGAN CT Audit #: 1403405 OL Status: VAL Issue Date: 11/01/2016 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 04/25/2020 CDL Cert Status: None 522402831 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 9 DUNUGGAN CT Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 04/25/1951 Mailing IOWA CITY, IA Sex: F City/State: 522402831 History Information Convictions Citation Date Conviction Date ACD Explanation CountyJUR 939682 01/17/2014 01/23/2014 S92 Speed (10 mph B Johnson ]A under In 35-55 mph zone Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 109/0712016 939682 IA Name: Snyder, Janet DL/ID: 554XX0048 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: 10/30/2017 IOWA r...... TOP N8 Office of Driver Services Iowa Department of Transporation Name: Snyder, Janet DL/ID: 554XX0048 1o0ct.31. 20170. 3:49PMCab Div of Criminal Investigation (FAX)3193382%No.5160 P:.1/1/002 STATE , • • Criminal1 1 a(Check Request Form Tal Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 71h Street Des Moincs, Iowa 50319 (515)725.6066 (513)'725-6080 Fox I am requesting an Iowa Criminal HIStory Record Check on; DCI Acaount Number: _9967-F orapplluble) From: _ Yellow Cab of Ipwa City P.O. Box 428 Iowa City, IA. 52244 (319) 339.9777 Phonol nXr (319) 339-7302 Lest Name (mandsic First Name mandetoNl' I Middle Naane (recommended) St,ly A E P, ri`'� Date o'fBlrth mender ) Gander(mmdato 'Social-SecurityNumber rodommended `i' as - 19 s I❑Male WFemale aA.77 (°- 3 11 Waiver Information: Without a signed waiver from the subject of the rogvest, a compigte priminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal hlataryreooro Information, as allowed by law, always obtain a waiver sl nature from the sub act of the request, Waiver Rd100$dl 1 hrraby gnvo pernilwan for the above raquerting oalolol to conduct an Iowa criminal binary reenrd cheek will) the Dlvlllon ofCominol Invcalrgoion (DCO, Any adm(noi hlnoty deto concerning Inc That it melnuinad byCdU DCI may bo raleased as ellowul bylaw. WaiverSignarurer=�f IGd�Y-v��A�—"_ _ (Oct we only) As of a search of the provided name and deto of birth roveplcd: c No Iowa Criminal History Record found with DCT (,I rn ro �. 7e• •- C:) Iowa Criminal History Record attached, DCT 6 A y,, cn DCI initials DCI -77 (08/25/10) Received Time Oct.30, 2017 2:19PM No.4958 ct.31. 20170 3:44PMCebDiv of Criminal Investigation (FAX)3193302N2.5156 P.. 1/1,1002 STATE OF IOWA Jwj Criminal History Record Check "(A i., ;`y,�i a �:•• Form :,; DCI Account Number: •9. Tor Iowa Division of Criminal Investigation Support Operations Bureau, I't Floor 21S n. 7'b Street Des Moines, lawn 50319 (515)725.6066 (S1S)'725.6090 Fax I am requestin0 an Iowa Criminal Hist try Reonrd rhnnle nn - From: _ Yellow Cab of Iowa Clty P.O. Box 428 Iowa City, IA, 52244 (319) 338.9777 Phone: Fail (319) 3394302 Last Name (mnnduo First Name (mandatoW- I AUddle Name (recommended) Slily Q E Date of Birth (manditoryl I Gendar tm..dljao rsocial,SecurityNumber recommended Ll - a s - s ► [IMale I�1Feroale aa -1 ` L4 (e 3 117 Wa1ver1nf0r1ti4f10n- Without a signed waiver from the subject of the request, a oomple:te griminal history reoord gtoy not be releasable, per Coda of Iowa, Chapter 692.2. For comr1fit criminal history-reoord Infarmatlon, as allowed bylaw, oiways obtain a waiver signature from the subject of the request. Waiver Release:I hereby give perrnisttan for the above royuesiing omclel to conduu an town crlmtnsl binary record check with the Dlvlllon ofUnninal Invoiltgallon (DqO: Any otim(not hilanry data coneeming me Ihei 11 malnielntld by the DCI nlay bo raleased et allowed bylaw. - Waiver ftnalurei. u ,Lows Criminal History Record Check Results As of 10 - -3 ,)- �, a search of the provided name and date of birth rov®pled: DCI.77 (08125/10) Received Time Oct -30. 2017 2:19PM No -4956 (DD( use only) No Iowa Criminal History Record found with DCI ❑ Iowa Crlm{nal History Record attached, DCI # e5 DCI Initials r - DCI.77 (08125/10) Received Time Oct -30. 2017 2:19PM No -4956 (DD( use only)