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Home My WebLink About17-165J IDENTIFICATION NO. _1-1- ( t / (OfficeseU Only) �.:. -4 CITY OF IOWA CITY APPLICATION FOR IAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday -Friday) 410 Last Washington Strcct Iowa city. Iowa 52240-1826 Failure to complete the "required" information will result in denial o/ the alopfioation [3 19) 356-5040 (319)356-S497 FAX First Middle Low 1. Name (REQUIRED) _ _iCSE >o N 1,1��(ITI= Q- I .A s4 SL4 2. Address (REQUIRED) 4S3lP W4LNVT S1- 10WA TTY Si} $,Tdc/t) 3. Contact Information (REQUIRED) Email: .\Wjg0T&lLoflttwr1.4A4 Cell Phone: 3i959y.2i 0T (All written communication sent via email) 4a.Driver's License expiration date (REQUIRED) 05- -at/A0/7 C 7eim4-4,ttt b. Taxicab Business Name (REQUIRED) _ �� IC , Lab (A- X-OW 6., 5. Prior experience in transportation of passengers: Five. yec,. 5 wr 4, rNGVcoS Twp uv..�5 r tL\ WCA41k 4. col�i,5^�, .Lr,ilJauti 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? A) 0 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? yC�2 T Type of offense Where When 9-%3-2013 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A10 Type of offense Where ti 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please p e the r �r"I 2 T 1 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERT-WIED 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 Transportato a valid Driver's license number ��7 /�{ $fit/ 7 Z issued on Ot/„21 ZOt7expiring on �^S � t/- 20� 1 understand that if I falsely answe yanr 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_01 2/ .Z 0 / STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by _�- oSpja,6 L_A� . I—pL 51�_ w-, Lon this Z-) _ 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 q (2 1-2,0,7 (2�15V _ Signature of Police Chief or designee 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 Clerkor designee �-!'¢ p A Dale l to 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 Clerkor designee �-!'¢ p A Dale 06nffA%IDRNBADGEAPPL91014errergaC DOC 07/2016 0 Office Use Only -i �"v ij --I V �� 7 ^: N Approved application _t c) �n m DClreport s State certified driving record ° o Website update rr r1) 06nffA%IDRNBADGEAPPL91014errergaC DOC 07/2016 OPIOWADOT wwwiowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Moires, IA 50306-9204 Phone 515-244-9124 1800-532-1121 1 Fax 5155-239-1837 www iowadol gov Certified Abstract of Driving Record Inquiry Date: 4/21/2017 DL/ID V: Customer 0: 5231945 Class: Name: Laskowski, Joseph Walter Audit 75-: 127AC8472 (]A) D 5981226 Address: 836 WALNUT 5T Issue Date: 05/15/2012 Expiration Date: 04/25/2017 City/State: IOWA CITY, IA 522403340 Endorsements: 3 Mailing 836 WALNUT ST Restrictions: Corrective Lenses Address: 757141 Restriction None Mailing IOWA CITY, IA 522403340 Supplement: City/State: None DL Status: Date of Birth: 4/25/1973 None Sex: M History Information Convictions CDL Permit Class: None COL Permit Issue None Date: CDL Permit None Expiration Date: )9/07/2012 CDL Permit None Endorsements: 757141 CDL Permit None Restrictions: Iowa Department of Transportation ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None :itation Date Conviction Date ACD Explanation County JUR )9/13/2013 10/02/2013 593 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the Individual was at fault or given a citation. tccident Date Case Number JUR )9/07/2012 703362 IA )9/13/2013 757141 IA Name: Laskowski, Joseph Walter DL/ID: 127AC8472 Pursuant to Iowa Code §321.10, 1, 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: die :..••...-s• 4 4/21/2017 o; o y '`f/f'Be1 i Office of Driver Services ,ham, Iowa Department of Transportation Name: Laskowski, Joseph Walter DL/ID: 127AC8472 t -•041APr_19; 20113 1-'I M Div of Criminal Investigation DCI I0ANo,8660 P. 1/1 Ai 19 STATE OF IOWA Criminal History Record Check Y Ra patForm r 'Pe DCIAccount Nrmmher�^'w ormsw— Tot IMM DMHoaatcdmtndrovartij"atioa l+roml i11i1ttYt.S I AJrI 5oppartopewi mstowo, t•rroar 4 Skwa a pr. 115 E, 7'' drat VxrdoWt,1avm sw19 aw A s7mo (61� 71s60i6 (315)"saw Fa: pboua ,i3ta 338- a9'j tbr, 319 351' ` As of qr (-1= —1�. it aoatoh of tha provided name and date ofbitth wvealed 04,No ima Comlaei Hi" Record found with DCI Q Iowa C11minei History Paid eitaoIA DCI 0 'DCI (nittelL-Si�L Received Time Apr, 11. 2017 12:49PM No. 8414 caQvlom�