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Home My WebLink About18-035CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1 82 6 (3 19) 356-5040 (319) 3S6-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. I IP7 �j s (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the "required" information will resutt in denial of the application 2. Address (REQUIRED) 1'46-3 'GJe7fy:'tw c?K wra 4v, Ile � :7A y'z Y/ 3. Contact Information (REQUIRED) Email: C 104,C Lt.L @ CXru— /• Cc 1n Cell Phone: 3 (a - 5-911(-19$2 (AII written communication sent via email) i 4a. Driver's License expiration date (REQUIRED) r ' Z I' %C 2 v {3 b. Taxicab Business Name (REQUIRED) 1 ow ( a 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 1%! Type of offense Where<C. �7� When e i r,. - - t . _ LI — - What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? Iio f � Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A/0 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) Al _ N O DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE c R DIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE,�F RgVIEj= :�c-) `a You must apply for an individual Department of Criminal Investigation Report (form aval up8n rel"t). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTAR�::Y-, w D A ON 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 3ig �� 175-9 issued on 3-K6-70 xpiring on q -Z11-7023 . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of T' le 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicantL Date J - Zc{ ?oo v ffflfllffffflffffflfflff1f11flfffffflffYtltff iffYfffflff#1ff�YMlRllffflffflfflflffff1f11ff1fHiylfffffffYflfff11f1fff111111lflflXflfYIK11ff11f STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1 f ; <;kirn al.,n r ,:T Ln Ci? cA on this �_ day of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license o3-Z9-/� Signa a of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. i na ure of City Clerk or esignee Approved application DCI report State certified driving record Website update Date m Office Use Only -'" m O� W D o N CWrAXIDRRMnDcen 92014am,eaaDOC 07/2016 aMar_ 20.._20186 8:54AMieabDiv of Criminal Investigation PHI No.(TAX)3193361./uG 383 P. r.002i002 STATE . IOWA r IaL.ry '�/ l• Criminal 111story Record Request Form . It To: l0wa Division Of Criminal Investigation' Support Operatlons )lureau, 1'r Floor 215 P. 7'" Street Des Moines, Iowa 50319 (515) 725.6066 (515)725-6080 Fax Lo 4c� 'i-ZH-79.. VWSr Name (mendmort) DCI Account Number: 9967-F (inapplicable) From: Yellow CAb•of Xowa Ci P.O. Box 428 10Wa Clty, XA. 52244 - (319) 338-9777 Phono: 'Fax: (319) 339.7302 ON'emale HZ)I.—aW—Iezqc'� watverAformanlon: Without a signed waiver from the subject of the request, a complete gr(mtnal history record may not be retlessable, per Code of lows, Chapter 692.2. For compIcto criminal history -record information, as allowed by law, a)ways . Waiver,kelea8e' I hereby give pertnlsslon ror the above requesling ofneiat to cenduot an low& criminal hlsloryrecord chcckwhh the Division of Criminal Invearigasion (DCD. Any ■dmiml bin cry data concerning mo (hat h maintained by rhe DO tnoy be released 4 dlowepby law. Waiver Signature: f LOwa Criminal History Record Check Results As of 3" a�U ��o a search of the provided name and dole of birth o Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI 4,, DCI itutiels�� DCI -77 (08/25/10) Received Timt Mar. 15. 2018 6:39AM No.5612 (n(1l we only) Pled!�� ` � M1. N O T+ �--. .;o.. C:)f rr Iowa Department of Transportation 0 Olice of nfww Services (Toll free) SOD -132.1121 PO Box 9204, Des Montes, to 503069204 515-244-9124 FAX- 515-23&1837 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 3/29/2018 DL/ID #: 769YY1758 (IA) Customer #: 1272105 Name: Lottich, Christopher Class: D ID Status: EXP John 03/04/2009 12/21/2009 038 Address: 1463 WESTVIEW DR Audit #: 8934357 DL Status: VAL Issue Date: 03/18/2015 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 04/24/2023 CDL Cert Status: None o 522411031 Endorsements: Chauffeur 3 CDL Mad Status: None Mailing Address: 1463 WESTVIEW DR Restrictions: NONE Restriction None Supplement: Date of Birth: 04/24/1979 Mailing CORALVILLE, IA Sex: M City/state: 522411031 History Information Convictions Citation Date Conviction Date ACD I Explanation lCounty 3UR 06/19/2016 07/07/2016 M14 Fail to Obey Traffic Johnson Si n SI nal IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 12/22/2008 480109 IA Sanctions Type Effective End ACD Exqlanation occurrence ]UR 7UR Suspended 03/04/2009 12/21/2009 038 Fall to Post IA IA' Security for an m Accident o = DZq 70 n� � r - Name: Lottich, Christopher John DL/ID: 769YY1758 �rn —O M ca 0 O� ca Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departmeht of Trar�brtation, 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