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Home My WebLink About13-273 • Authorization Number l� _ c) - 1 (Office Use Only) -- -It saga ogillir CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Strcct between 8 a.m. to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Jl ast 1. Name i i a C�- C-LA.G 116— l ‘,C 2. Mailing Address f`/o L/ 0r i it j>�_ C 1,t j.1 ,�cf 3. Telephone: Home 3 167 -�-5(- G, 3 S Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /vo 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? .11C Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years?AP- Y ' Type of offense Where When 5 pi red TC V2 - 2.c - ao1I Flt,/ U.�/ ''C� fi t� Cy yG,�.�'�C 5�� 0 5g-_o - Ze 1 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? //./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 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerWtaxidrivbadg 03/2013 • I hereby certify t at I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number y 7 Lo 9 Y� 9 D/ . 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 Date /i —2—/ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by _ �Ucw k. C . On this H day of `", Nota??-Pulhc in and for the State of Iowa 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). Si ature of oli e Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. 72 Signa e of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derk/taxidrivbadgeapp2010.doc 03/2013 I Iowa Department of Transportation , Of ice of Driver Services (Toil Free)800-532-1121 PO Box 9204,Des Moines, IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 4/17/2013 DL/ID#: 769YY9401 (IA) Customer#: 2348748 Name: Tiet, David Cuong Class: D ID Status: None Address: 1404 PRAIRIE DU CHIEN RD Audit#: 2117117 DL Status: VAL Issue Date: 05/07/2008 CDL Status: None City/State: IOWA CITY,IA 522455614 Expiration Date: 01/04/2014 CDL Cert Status: None Endorsements: 3L CDL Med Status: None Mailing Address: 1404 PRAIRIE DU CHIEN RD Restrictions: NONE Restriction None Date of Birth: 1/4/1970 Supplement: Mailing City/State: IOWA CITY,IA 522455614 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 02/24/2011 02/25/2011 S92 Speed (10 mph&under in 35-55 mph zone) 52 IA 07/31/2011 08/01/2011 M14 Fail to Obey Traffic Sign/Signal 52 IA 12/0/2011 03/14/2012 M14 Fail to Obey Traffic Sign/Signal 52 IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/31/2008 469206 IA 02/13/2009 494177 IA 06/06/2010 575119 IA 02/03/2011 615890 IA Name:Tiet, David Cuong DL/ID: 769YY9401 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: _,--1411))14,, ,O$ .,4q 4/17/2013 tr */ a 11,'lieDBIVIERSR�J`/ IowaDepartmentof Driver of Services ansportation Apr. 16. 2013 4:24PM Div of Criminal Investigation No. 0500 P. 2/2 np I. ,rL. LV IJ L.V II fl Lily '.cern — t•ity UI taws 41ty No. 1)00 P. 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