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Home My WebLink About13-243 r % Authorization Number l S - y 1 (Office Use Only) :-I®Ar i :JI1 'It AM gill i iliair APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 CFirt cel pp Iddlef 1. Name f iV OtI)c 2. Mailing Address 1L-ct `s 1 Lf c.L.n.,‘ \..cn...c mac)s"!-L- \...1\c.sly 52-3(-) 3. Telephone: Home 31\ `l-7 - S1 'SL-1 Other: 4. Prior experience in transportation of passengers: (a -J rv_;�eJ' r~A3YAAiZ YCi.fiv; stes5 rum nowt,. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or Isewger 'Trc• Type of offense Where When k.�.-11-v.L1 C...---&--e-k -.- C. s eJ s cs s 6. Have you betxrconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? f�','` Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? j- Se,k- (3)el t- (kms Type of offense Where When 8. Has your driver's license or chauffeur's 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) 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) clerkttaxidrivbadg 03/2013 I hereby certifythat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 0c-_1 A4 '-10 7 . 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) % `\ / T,„ Signature of Applicant _ 9 Date ( L^ 1 3 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by t tA.-. (-) \ . On this 8-t1,� day of 71/4 0°4,4, WENDY S.MAYER 1 JQJ-� S Kul .mmission Number 729428 Notary Public in d for the State Iowa ow ►- l 9 ************************************************************************************************************************************************ 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). ./A/0 3 gnature • Police 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. / -_ - -7j2�� /CD/ 1/L5 Signa re 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 clerk/tabdrivbadgeapp2010 doc 03/2013 Iowa Department of Transportation u Office of Dever 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: 10/4/2013 DL/ID#: 047AA4079 (IA) Customer#: 2566862 Name: Opel,Chad Michael Class: D ID Status: EXP Address: 1475 HAYDEN LN Audit#: 7406733 DL Status: VAL Issue Date: 10/04/2013 CDL Status: None City/State: NORTH LIBERTY, IA Expiration 08/17/2018 CDL Cert Status: None 523178102 Date: Endorsements: 3 CDL Med Status: None Mailing Address: 1475 HAYDEN LN Restrictions: NONE Restriction None Date of Birth: 8/17/1970 Supplement: Mailing City/State: NORTH LIBERTY, IA Sex: M 523178102 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/28/2012 05/01/2012 F04 Seat Belt Violation Johnson IA 05/18/2012 07/02/2012 F04 Seat Belt Violation Johnson IA 08/10/2012 09/06/2012 B20 Driving While Suspended, Denied,Cancelled, Revoked Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 08/07/2012 09/30/2013 D53 Non-Payment of Iowa Fine IA IA Suspended 10/10/2012 09/30/2013 D53 Non-Payment of Iowa Fine IA IA Suspended 03/14/2013 09/30/2013 D53 Non-Payment of Iowa Fine IA IA Name: Opel,Chad Michael DL/ID: 047AA4079 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: .�. . 4® ... . . 14 10/4/2013 's4 IOWA IA ,,,V D. O. T.All ( 314raIM elecopeviA +I'1 ®f•®� �$ Y owlaeof Driver Departme tofServices ansportation Name: Opel, Chad Michael DL/ID: 047AA4079 Y Oct.I5. 2013 6;35PM CDiv of Criminal Investigation, NNo. 8235 P. 1/1 • STATE OF IOWA 4/47fr /P. ..1V Criminal History Record Check l i° lovin 1 ;1 : 1' :1L. - 'I .; Request Form TrA DCI.AccountNumber: BOO -F (itepplicablo) To: Iowa Division of criminal Investigation From: CITY OF IOWA CITY Supper(Operations Bureau,1"Floor CITY CLERIC'S OFFICE 21$E.7th Street 410 E WASHINGTON STREET Des Moines,Iowa 50319 (515)725-6066 IOWA CITY IOWA 522110 (515)725.6080 Fax Phone: 319-3565041 Fax: 319-356-5497 Yam re uestin_ an Iowa Criminal Histol Record Check on: Last Name (mandatory) First Name (mandatory) Middle Name(recommended) (Q ` C— � v . c (X `` —k6\eNC- 1 Date of Birth(mendsIon) Gender(mem/dory) Social Seeuri Number(recommended) ccE r- 1 ` 7 alale ❑Female 4t--2_ ^ D t " I-7 z3 Weibel'Information;Without a signed waiver from the subject of(he request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692,2.For complete criminal history record Information,as allowed by law,always obtain a waiver signature from the sub loci of the request. Waiver Release:I hereby give permission thri vorequcsling official to conduct en Iowa(Amino!history record cheek with the Dividon oteriminol lnvesligation(DCI). Any criminal history data come Ing that Is me Ind by by iho Det may es ellooby Ism, Waiver Signature: �/�' •(�� - 21 , d Q Iowa Criminal History Record Check Results (DCI use only) As of' I 0' -J3 , a search of the provided name and date of birth revealed: • No Iowa Criminal History Record found with DCI • . 0 Iowa Criminal History Record attached,DCI# DCI initials c1 Received Tlinen ct.- 1. -(2013 2: 52PM No. 7750