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HomeMy WebLinkAbout12-060r ► r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX `111111111i:13iiLa Authorization Number a' -" 60 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle je hr 2. Mailing Address sig S + S-�- 3. Telephone: Home I- D d — (, ((� Other: 4. Prior experience in transportation of passengers: Lf ti P ti /.5 o -F T�'l(I L 5 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ✓t J Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? d) D Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Tvpe of offense Where �^1��anP� �r4i1'I/' 'Fai✓I J4- Cr4"r„ V/51 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? 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) V1 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) der Widrivbadg 09/2010 ljlQAD9'7.2te I hereby ce. i that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 1�ii D J-2 26 . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 V Date STATE OF IOWA ) COUNTY OF JOHNSON ) T Subscribed and sworn to before me by On this �lk5 day of in and for the State of Iowa t*#fif#!f#ff#ff#1f*R**M**#*Y#R4Rt*R##**i*#f4tf#titi#M#f*i*t*##R#ift#*iRRttRF*RR#*iR#RR*#*RY*R*Rt#t*Y*#YtMf*#MY##*t*##t4MYt*tht##Yf*Ytt**#*f I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). 'Signatufe of Police Chief or designee �.L !/ Signature of City Clerk or designee Date a -a S -/a Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update clerW idnvbadg a,201 o.d« 0912010 CA Iowa Department of Transportation Office of Driver Services (Toll Free) 8[il>i 532-1121 PO Box 9204, Des MDines,IA 50306-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 2/28/2012 Name: Buns, Bret Jene Address: 809 S SUMMIT ST City/State: IOWA CITY, IA 522403337 Mailing Address: 809 S SUMMIT ST Mailing City/State: IOWA CITY, IA 522403337 Convictions Certified Abstract of Driving Record DL/ID #: IBOAD9726(IA) Class: D Audit #: 2793343 Issue Date: 12/02/2008 Expiration Date: 11/16/2013 Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 11/16/1982 Sex: M History Information Customer #: 4296819 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County JUR 11/23/2009 112/15/2009 ;592 Speed .52 _ ?IA 04/20/2010 X05/18/2010 ;Improper Registration X52 PA i Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 10/07/2003 iA61 ;Under 21 -Alcohol Content .02 but less than .08 iIA Sanctions Type Effective End ACD Explanation _ Occurrence JUR JUR Revoked 10/18/2003 ;12/1m7%2003 ,A61 '�lcohol Content .02 but less than .08 IA JA Name: Buns, Bret Jene DL/ID: 180AD9726 Pursuant to Iowa Code §321.10, I, Kim Snook, 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: """•: i,J;vp 2/28/2012 10W . -M,. *°,r D. 0. T. ry ., 7f'••••"$ OBIVER�= Office of Driver Services a Iowa Department of Transportation Name: Buns, Bret Jene DL/ID: IBOAD9726 n2/:Feb. 20. 20121 IO:OBAM Div of Criminal Investigation ncI toe•No. 4648 P._ 4/7,eo7 6) STATE OF ]IOWA''''<.. Criminal History Record Check _ Request Form Tot lavve 111vlelou ofCilmhtel lavedig4r," Sdpport opennoae Barms,10 Floor 2166, 7• StMl De■Molnes,lowa 50319 (stsl'nmw (6157 723.6080 Fax DCI Account Number:8'13 (vappilu From• IM4�c.s 0.x1 S�tvt+.s ©r• • olaw pC S�.3N o pho■et (A 3s8• any. F.et .919 SSI � i 4 was waw, wuv.•o v.uu... IJeaMame 1 First Name isarrontso Mlddly Name t l3yns Q��`f' .' Jew, pate at Birth oamwm Gender rtaMae sogial Smart Namher I l, l 6 '" 8 �. f"Mafe ❑Female 4 ��( 04 002— (; WaiverinfornWrlant Wahoet ■ alpaed waiver from the eobleet of tie regtwl, a complete criminal h1eGry neord meyoot be relagbl% per Cede otloo, Chapter 012• Fbr rsmalrla t ttmlaal hhlary record tarormatlon, a allowed by itw, ■lw■ya obt■inawaiver apalgro ftemtieaebactorthe EMert. Walver,lWossa,chord+eamnhwenroeamw,ewaxMemewwArCMW tevmtp&npteq, Ac'otnibaMigoydmc--64 eblill—kftM VONDCt ielasedualleww. Eybw. Waiver ftnWUro: /fin„ As of 9—RIO—/191, a search of the provided name and date of birth revealed: No lows Criminal History Record found with DO , {] Iowa Criminal History Record attached, DCT # Kc Received Time Feb. 14, 2012 2:17PM No, 9179