The URL can be used to link to this page

Home My WebLink About17-151r � r I CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 826 (319) 356-SO40 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. I %— (Office Use ly) 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 3. Contact Information (REQUIRED) Email: d 10D 6, 1 cwr Cell Phone: (AIrWritten communication serl via email) 4a. Driver's License expiration date (REQUIRED) \T b. Taxicab Business Name (REQUIRED) Y'(U CWW _ GF IGWA C I Tf 5. Prior experience in transportation of passengers: SW[F AkV ZO 17 W1 n} YEiccw C^. JA( Tjf, d qU' S I tu6rttte9 k4t A PP4ell� S ` OW -5 wt-ry Ye"ua✓ t c't-9 (AP I vv 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? j o Type of offense What happened to the charge? (Circle one) Where When 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 When �fL/-'q tIvN 2�& �Aog,�� c 1i UM JK FAIUAV ; --b nf-4 s9foic slcum- Avvl t t "q4yw 1r!41C r�( ti�lg� t What happened to the charge? (Circle one) o —n Convicted Dismissed Deferred Suspended lead Guilty Cgher{ 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five ye�Q �— Tvoe of offense Where r1l 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 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 valid Driver's license number }�j7o Y / 49 issued on expiring on 1 Z I 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 Applicants ` ey1 / >� Date 11./%/17 lfffHH1HlH1fHH11flHHf f11f#HHH{HHHf!!f f f!!f 1HHHlt H1HHHlHf flHfH11H11Hffflf f lfff f lfHlHlf Hff1f lf4Yy {lH4fH111111Hf ff Y STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed nd sworn tcfefore me by Public in on this q 1 -, day of dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration dat ofriv 's license I h or designee I// s//7- 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. u4, Signat re of City Clerk or esignee Office Use Only Approved application DCI report State certified driving record Website update oerk/T"DRNBADGEAPPL92014amenae0. DOC q AN_ 7 yCm � c- 07/2016 10ov. 6. 20111 8:41AMcat>Div of Criminal Investigation (FAX)31933821o.5545 P. 1/B002 STATE OF IOWA/fr Ott ICriminal History Record Check i� 16kr4� ,r��ar •°Request Form To: Iowa Dlvlslon or Criminal Investigation Support Operations Bureau, Vt Irloor 215 E.7" Street Des Maines, Iowa 50319 (515) 735.6066 (515)'725-6080 Fax I am reouestiner an Iowa Criminal Marnr,, TI.—A r•w.,.t. A DCI Account Number; _9967-F (irrpplic.ble) Froml _ Yellow Cab of Iowa City P.O. Box 428 ' Iowa City, IA. 52244 (319) 338-9777 Phone: Irei (319) 339-7302 Last Name Imandmoy)Firat Name mondatn )m Middle N mo recommended) ��a � G � M Date ofBlrth mandate Gender mandato Social. Securl Nutubor rocommondod q J�� Z t /_ 7r / *2Malo ❑Female 4 b2_� S`g- 7 S��l Waiver Information. Without a signed waiver from the subject of the request, a complete oriminal history rocord may not bit relaasablo, per Code of Iowa, Chapter 692,2. For eiritrie crlmtnal history record Information, at nllowed bylaw, always obtain a walvcr sl nature from the nub eet of the rtguest. Waiver Release: I hereby give permission for the above requesting official to conduct en IOwt Criminal history record check with the DlvBton of Comltul Invealisetion (DCD. Any criminal history data t0noC/mning me that I alntalnrd b rho lHtt may be relcued ee ii bylaw, . Waiver Signafurel _t/� 1 l j\ 11 1 \ ..• ++.�..,• . .a.wvau vaa� a.aw .aww wan c N(DCI use only) As of . 4 search of the provided name and date of birth ravealedi ? "=`; Wit.. —n No Iowa Criminal History Record found with DCI ;E ❑ Iowa Criminal History Record attached, DCI DCI initials. 4, DCI.77 (08/25/10) Received Time Nov, 3. 2017 9;31AM No.5443 ?' IOWA D. 0. T. Name: Kramer, Gale M DL/ID: 556YY2949 11/3/2017 Office of Driver Services Iowa Department of 7ransporation O � Z*C!) O M w CIowa Department of Transportation AO 00ce of Ofarer Sefvwdm (Toll Free) fiat -532-1121 PO Boot 9204, Des Manes, IA 503069204 515-244-9124 VAX .: 515.239 1837 Mailing Address: 2890 HIGHWAY 1 SW Malling city/state: Convictions IOWA CITY, IA 522407605 Endorsements: Chauffeur 3 Restrictions: Corrective Lenses Date of Birth: 01/12/1959 Sex: M History Information CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Ex lanation Countv JUR 12/03/2015 01 07 2016 592 Seed Washington IA 02/19/2016 03/15/2016 M14 Fail to Obey Traffic Johnson IA SI n/SI nal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. — 1Ci Name: Kramer, Gale M DL/ID: 556YY2949 M -n >a Pursuant to Iowa Code 4321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departrwt of Transportation, do jr 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: Certified Abstract of Driving Record Inquiry Date: 11/3/2017 DL/ID #: 556YY2949 (IA) Customer #: 1998958 Name: Kramer, Gale M Class: D ID Status: None Address: 2890 HIGHWAY 1 Audit #: 7687981 DL Status: VAL SW Issue Date: 01/10/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/12/2019 CDL Cert Status: None 522407605 Mailing Address: 2890 HIGHWAY 1 SW Malling city/state: Convictions IOWA CITY, IA 522407605 Endorsements: Chauffeur 3 Restrictions: Corrective Lenses Date of Birth: 01/12/1959 Sex: M History Information CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Ex lanation Countv JUR 12/03/2015 01 07 2016 592 Seed Washington IA 02/19/2016 03/15/2016 M14 Fail to Obey Traffic Johnson IA SI n/SI nal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. — 1Ci Name: Kramer, Gale M DL/ID: 556YY2949 M -n >a Pursuant to Iowa Code 4321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departrwt of Transportation, do jr 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: