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Home My WebLink About13-246 • Authorization Number PS —a r 1 (Office Use Only) =.`I ti' 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 ast 1. Name 6L'D z �' CY 2. Mailing Address /2/2 /t7O'Z',s-741H T ? ,e/w/ /b ice G; fy ///. 2'/6 3. Telephone: Home .5/9- S./ 2 " SO 767 Other: 3/9 - - �✓1> - /327 9 4. Prior experience in transportation of passengers: /70 _ _ t 443yaiu, .2 vns .v 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?uv, .'-h 0 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? i2 G' Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /-1 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A'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) /20 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) 03/2013 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 6 CC,3 3 2 Z . 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 4,10, Date /G2 /L/ 2 2/__? ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by y' ,cy..1 Q K i, nit° vtt4 . On this / 4—vik day of r,, WENDY S.MAYER Notary Public in and for the State 4 Iowa ^op'mssion Nwm0er 720428 • My Commission Expires ow -) LQ ************************************************************************************************************************************************ 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). •• Signa re of Pol t �e hief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. • - 4_ .. 1C!!5AA - Signature .f 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 clerkttaxddrivbadgeapp201 D.doc 03/2013 . iIowa Department of Transportation ►i« Office of Driver Services (fdl Free)80{]-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/10/2013 DL/ID#: 236CC3322(IA) Customer#: 4162561 Name: Kllmanov,Georgy Class: D ID Status: None Pavlovich Address: 1212 MORMON TREK Audit#: 7400667 DL Status: VAL BLVD Issue Date: 10/03/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 12/20/2013 CDL Cert None 522464415 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1212 MORMON TREK Restrictions: NONE Restriction None BLVD Date of Birth: 9/30/1971 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522464415 History Information Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 10/16/2012 1710063 IA Name: Kllmanov,Georgy Paviovich DL/ID: 236CC3322 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: ope ,........... 10/10/2013 M IOWAIt 1 a i 11 4 0...D. 0. T r �h1j��hgra ms`s Iowa Department Office of Driver eof Services Name: Klimanov, Georgy Pavlovich DL/ID: 236CC3322 Ioi10ct. 5. 2013 6:50PM Div of Criminal Investigation a DCI 1000. 8216 P. 1/1 STATE OF IOWA � a ( IOWA ) Criminal History Record Check Request Form i/a„rtPak�`: DCI Account Number:4383-FC prendiceble) Tot Iowa Division of Criminal Investigation From: Marco's Taxi Support Operations Bureau,l'Floor 110 Stevens Dr. 215 E.7a Street Des Moines,Iowa 50319 Iowa City,L 52240 (515)725-6066 (515)720-6080 Fax (319)337.8294 Phone: raze m9)351-8294 I am requesting an Iowa Criminal History Record Check on: Last Name (mmdelmy) First Name(meeeskey) Middle Name(recommended) �S e/thati 0V Get Vo — P Date of Birth (mandatory) Gender�er(mnnduoy) Social Security Number(,rcommendcd) L 9.9. 30, X97/ IMale ❑Female _9t SC7178C-4C Waiver Information;Without n signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code or Iowa,Chapter 692.2,For complete criminal history record information,as allowed by law,always obtain a waiver signatures from the subject of the request. Waiver Release;I hereby giro permission lbr the above requesting ofgoial to conduct en lows criminal history record check with the Division of Cr hind invsdgatlon(PCI). My criminal history duaooneemingmcthat is deed bythoDel me released as allowed by law. r Waiver Signature) Iowa Criminal History Record Check Results RN only) As ofat, tQ'S VS ,a search of the provided name and date of birth revealed: • • U^�, No Iowa Criminal History Record found with DCI • • ra ❑ Iowa Criminal History Record attached,DCI# • • DCI initialsY DCI-77(08/25/10) Received Time Oct. 1. 2013 5:51PM No. 7774