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Home My WebLink About18-038� r 1 � tllwlmr�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-SO40 (3 19) 356-5497 FAX 1. Name (REQUIRED) - IDENTIFICATION NO. /? (Office Use ly) 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 result in denial of the application Middle Last 2. Address (REQUIRED) ( V6,z, (Z�iP V -\a\ I 1(10LO 3. Contact Information (REQUIRED) Email: (ECell Phone: fL- ail 041,04 All wrf i 4a. Driver's License expiration date (REQUIRED) 12- ac b. Taxicab Business Name (REQUIRED) _ �R(•\n C, a\) TCS C{ tfi 5. Prior experience in transportation of passengers: v, Pr w- N--�(A (, Dv --A 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Q— Tvce of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where w What happened to the charge? (Circle one)rn _ � 0 Convicted Dismissed Deferred Suspended Plead Guilty':5theP 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years.? Tvce 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 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 CA 112J.Dissued on 3 13- O SS expiring on 14 - I Z- a2, . 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 Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of STATE OF IOWA ) COUNTY OF JOHNSON ) Date y 3 - ( 1; Subscribed and sworn to before me by Rkr on this c/ day of Apr; I ZVf '�-) p OY S. MAVER � 5 WEN Notary Publ in and for the tate oT Iowa Expre� 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 o��icense y7 0,/- 6'3 --lb 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. Sign lure of City Clerk designee Office Use Only Approved application DCI report State certified driving record Website update o_ O W �� rn <rn a 0 aerk(TMIMWanoceAWLMIaa�ooc 07/2016 O.Mar.26._2018a.11:13ANyCab Div of Criminal Investigation STATE OF IOWA 0imilial History k6.66 rd Check Request Form To: Iowa Dlvidoa of Criminal I6vectigation Suppport Operadow Bureau, l" Floor 21S 14sswet Dat Nolan, Iowa 50319 (5I5) 725-6066. (515) 725.6089 Sat I Am MUOStinitan Iowa Criiitmal HtataryRecnni,r h�-k nn- ff 19338iauor 1231 P. l x21002 DCI AecountNumbar.'. _ 9967-P (if applicable) From; Yellow Cab of Iowa City P.O.:$oz 428 Iowa.City., IA., 5=44 Pbone: (319).338 9777 P8x (319)339-7307 Lastlti&ata (meadoxy) First Name t nndm Middle: Nacho (,,c� t .0 Date of h Gender (maode, ). So -*(*1 $ecurity Numlie>r, 1314lale, engale. Walverht or»1adorl: without a sigbed waiver from the subject of the request a complete criminal history record may aot be reldluabl6, per Code orlawa; tbaptor 692. F'or comolete'ar*bildblkory rxcord Information, as allowed by law, always obtain It wejvers ataiefrom otsu ect'otthirquest. Wt Iver $efease: iae,eby Dye pamlaiat he the above,regocsle6 atdotat to oundua a towecr ndoal bblory iroorq pluwkwith rhe-Diyhloa otcHw e1 IN,ma aauoe M A* arhnilial Agiorydata edaeemiagmi t),alit MkWalaad by the IC muy be.retaaad as Allowed by law. wafversipatuse: Iowa CrImililat History Record Cgcelr Results As of 3 - a searbh of the prOided name and dated f birth revealed `-) w m -o m No Iowa Criminal history record found witl) DCI'; tv 'D N_ ❑ Iowa C61inal History Record MthDCIDCI initials DCI -77 (08/25/10) Received Time Mar.26. 2018 2;36PM No -6165 Iowa Department of Transportation pp Office of Drw Services PO Box 9204, Des Mattes, IA 5030&9204 (Toll Free) 800-532-1121 515244-9124 FAX 5152391837 City/State: Mailing Address: Mailing City/State: NICHOLS IA Expiration Date: 04/12/2023 527667711 Endorsements: Chauffeur 3 PO BOX 93 NICHOLS IA 527660043 Restrictions: Date of Birth: Sex: Corrective Lenses 04/12/1981 History Information CLEAR DRIVING RECORD Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 CDL Cert Status: 3086333 None VAL None None CDL Med Status: None Restriction None Supplement: Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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. ry Q In witness whereof, I have caused my signature and the seal of the Department to be set upon this doct&nt, at;keny, Iowa this date: �ewmw�, CZE I 3/27/2018 —iC' W rn D: 0. T Y / I /deet Y l- s Office of Driver Services Iowa Department of Transporation Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 Certified Abstract of Driving Record Inquiry Date: 3/27/2018 DL/ID #: 433ZZ2783 (IA) Customer #: Name: Purdy, Rochelle Class: D ID Status: Marie Address: 518 NICHOLS AVE Audit #: 2626679 DL Status: Issue Date: 03/13/2018 CDL Status: City/State: Mailing Address: Mailing City/State: NICHOLS IA Expiration Date: 04/12/2023 527667711 Endorsements: Chauffeur 3 PO BOX 93 NICHOLS IA 527660043 Restrictions: Date of Birth: Sex: Corrective Lenses 04/12/1981 History Information CLEAR DRIVING RECORD Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 CDL Cert Status: 3086333 None VAL None None CDL Med Status: None Restriction None Supplement: Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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. ry Q In witness whereof, I have caused my signature and the seal of the Department to be set upon this doct&nt, at;keny, Iowa this date: �ewmw�, CZE I 3/27/2018 —iC' W rn D: 0. T Y / I /deet Y l- s Office of Driver Services Iowa Department of Transporation Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783