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Home My WebLink About13-261 Authorization Number J .. L r! osj 1 (Office Use Only) III mpit CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name 1b\,\\I \ p S o-C- ��iA�n�r1 C 2. Mailing Address P E K 3. Telephone: Home 3 Other: 4. Prior experience in transportation of passengers: 1 a _ 3 ) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you teen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1 Q Type of offense Where When 9. Have(ou ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) Jv� 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) clerwlaxidrivbadg • 03/2013 1 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number W'3 ' w \A S . 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) \ i Signature of Applicant 1�Dos-4 %\e,, ,� Date \ 1 ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Suibribed and sworn t9, before me by ,t 1 CL /1 C2 rc u.)C /_. On this / 5 day of KELLIE K.TUTTLE � [ (/� Commisgsioo Number 221819 Notary Public in and for the State of Iowa 2-r 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). TIJ'� 1/l5' ZOfI Signature of olice Chi 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. 17/ le // b3 igna re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z"(width) and 5 Y" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application • DCI report State certified driving record Website update derk/taxidrivbadgeapp201 0.doc 03/2013 Nov, 14. 20131 2: 08PM Div of Criminal Investigation No. 5096 P. 1/1 X • Aur. u. LVIi V•JvniTI vi Ly vi cia "1 (7 vi IVird Vlty NV 'tVQI r. Lii Lou 44‘) ::i"�o� a. STATE EflY1C� OF IOWA , a't tD.4,. is4� owe ei Criminal History la'ecord Cheek, _ ( `' • t\11�' �'J1� Request Form ^oivir DCL Account Number: LA504-/,/-� (if epplicabtc) To: . Iowa Division of C%im1flI Investigation From1 CITY OP IOWA CITY Support OperatiotsBuroau,idpioor• t'ITY CLERIC'S OFFICE 215 E.7°i Street 410 $ WASHINGTON STREET Des Moines,Iowa 50319 (515)7254066 e 016)125-6080 Fox Pholte; 319-3565041 raw 319-356-5497 I mn requesting an Iowa Criminal Hisfory Record Check on: ' Last Name oneaslosy) First Name(mandatory) Middle Name(recommended) `-\ Pisf*bw lc--.1c t PV 1 (J S col-T., Date of Birth(mr idatorp Gender(mandatory) Social Security Number ber(rccommended) 2 tL^LP5 JMale DFemale H t " I 9 1 p (09 Z, WaiverXiiJormasiotr:Without a signed waiver from the subject of the request,a complete criminal history record may not he releasable/per Code of Iowa,Chapter 692.2.For colnyletg criminal history record information,as allowed by law,always obtain a waiver signature Thou the subject of the request. Waiverllekease;Thereby give permission for the shove ruryestIng official to conduct anima criminal historyrecord check wills the Division of Criminal Investigation(OCI), Any Griming buoy data concerning me that l Inlalned by lhobClmay.salaried nn allowed bylaw. • (,3 � Waiver Signature: ".•e ‘ t . Iowa-Criminal History Record Check Results (DCTeae on(y) As of k\\\MX\3 , a search elSe provided name end data of birth revealed: No Iowa Criminal History Record found with DCI 0 Iowa Criminal History Record attached,DCI# ACI initials > • Received TimeTNov. 6. 1(2013 8: 55AM No. 4064 i Iowa Department of Transportation Otf ce of Drw f Services (Toll Free)8-06532.1121 11,1PO Box 9204,Des Milnes,IA+niB6-9204 515-244-9124 411111. FAX.:515.239.1837 Certified Abstract of Driving Record Inquiry Date: 11/14/2013 DL/ID it: 430WW4335 (IA) Customer#1 716612 Name: Hardwick, David Class: B ID Status: None Scott Address: 275 JUNIPER CT Audit#: 5518998 DL Status: VAL Issue Date: 09/20/2011 CDL Status: VAL City/State: NORTH LIBERTY,IA Expiration Date: 02/22/2016 CDL Cert Status: None 523179200 Endorsements: LPS CDL Med Status: None Mailing Address: 275 JUNIPER CT Restrictions: NONE Restriction None Supplement: Date of Birth: 2/22/1965 Mailing NORTH LIBERTY,IA Sex: M City/State: 523179200 History Information Convictions Citation Date Conviction Date ,ACD Explanation County JUR 09/08/2009 10/05/2009 592 Speed MO Name:Hardwick,David Scott DL/ID:430WW4335 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 authorised 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: N.wt ICif L ii11/14/2013 a. Ni €k IOWA :$\ alk: 5a ; : n .r eiCoa talk D. O. T.;mai l' �•ddi,"• Office of Driver Services hr,y m '� Iowa Department of Transporation Name: Hardwick, David Scott DL/ID:430WW4335