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Home My WebLink About18-054 IDENTIFICATION NO. F _ 1 - t (Office Use Onl Y) aZ1111421;//kit ti ite ma APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required"information will result in denial of the application Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAXO m) s 3 gn -� Last 'M'OrJT First N/tMiddle /`� '` 1. Name(REQUIRED) t C 2. Address (REQUIRED) l_tj '/ 1 /do 1 . cl /4 H 4 Co rwr4 L Vt. )1e ~T4 3. Contact Information(REQUIRED) Email: Cell Phone:7.2'7- 33 0 - (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) I /i, / `2') b.Taxicab Business Name (REQUIRED) )00.1 CAB 5. Prior experience in transportation of passengers: ,2 VZ (Jr' ��. V �� i t, �r1 CA 1J y� 's 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? 00 Type of offense Where When O c0 7 -C _ —1 C C!1 What happened to the charge?(Circle one) r M Convicted Dismissed Deferred Suspended Plead``Guilt' 'Other 0 , 7. Have you been arrested/charged with any traffic offenses in the last five years? pw Type of offense Where When What happened to the charge?(Circle one) 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? ?' 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) O (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereby certify that I have issued to me by the Iowa De ant of Transportation a v lid Driver's license number -5 A �l L, 1 �- issued on 3 ( j7expiring on 'Z. O . I understand that if I falsely answer any questions in this application, that this appatiay be denied. I ree hat in makingthis 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 le 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date �� S **************************************************************************************************************************M**********AAAAA***** STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by %-3 C v;,tc h on this , day of NtagLPu lic in and for the State of Iowa Q I have reviewed this application, DCI report, and the State certified driving record of this applicaArand had*detalaied that there is no information which would indicate that the issuance would be detrimental to the safeteeilth gwelf4e of resi- dents of the City of Iowa City(Title 5, Chapter 2, City Code). -+ r rC� -o � 3 Q Expiration date of Driver's license /1./f. 202.0 - oS•l S•z./B Signature of •'lice Chief o .esignee 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. -41I,e cL `l ` % 5`- / Sign.ture of City Clerf•r designee , Date **********AA A A AAA******************************************************************************************************************************* Office Use Only Approved application DCI report State certified driving record Website update CIeWTAXIDRi,BADGEAapL92O18a ded.DOC 04/2018 May. I . /Old 10: 16AM Div of l;Hminal Investigation No. 14U1 r. I/ I From:ti'ty CT to WA Lacy CIefK f...31/106 .418 3E666B7 05/11/2018 10;21 �Of6YA p,pp2/002 .► STATE OF IOWA ;.. --�- , r• P� , Criminal History Record Check 1,- ' - .% Request Form ;../....--4.. DCI Account Number: o ° 3 – tz-' (if applicable) To; Iowa Division of Criminal Investigation From: City of Iowa Cit _ Support Operations bureau, 1`t Floor City Clerk's Office 215 E.71h Street __410 E.Washington Street Des Moines,Iowa 50319 (515)125-6066 Iowa City, IA 52240 (515)725-6080 Fax • Rhone: 319-356-5041 Fax: 319-356-5497 - 1 am requesting an Iowa Criminal History Record Check_on: Last Name(mandato ) First Name(mandatory) Middle Name(recommended) 1) U W1q 7- J CN• eN i s Date of Birth (mandatory Gender(mandatory) _Social Securi P. .� 4. 1 i 1i / L' 3 t � - -- 1 r 1 �� lYiale ❑Ferrate � 3 �� Waiver Trrformalior:; Without a signed waiver from the subject of the request,a complete criminal thVy reed ma paai be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,as alg). by law,alv obtain a waiver sigurenatfrom the subject of the request. .. W Waiver Release;I hereby give permission for the abov equesting official(o conduct an Iowa criminal history record check with the Division of Criminal Investigation(DCI Any criminal history data concerning m9'l aljaa maintained by the bCI may be reit . . lowed by law. Waiver Signature: «� 1 `^"' Iowa C iminal Histor Record Check Results ~T ,.. fTir As of 5.-f/5– i g- , a search of the provided name and date of birth reveal l: , — r.lf •1 51--P No Iowa Criminal History Record found with DCl -�'. te,:' ...• i : to 0 Iowa Criminal History Record attached,DCI# DCI initials DCI-77(06/25/10) • Received Time May, 11. 2018 9:40AM No. 8697 ti c-7`' '""1:\`,"Xw iowAD , � .*ri .• �""`':+ ,, 0 , Y 0; SMARM II'SIMP R I CUSTOMER ',1r a , , • ,,., IDtber&letnimation SWAM ISO Box 2204 1 Des Motes.K5030 Root 5'f544461241;FOX 515 394 • Certified Abstract of Driving Record Inquiry Date: 5/10/2018 DL/ID #: 445AF9612 (IA) CDL Permit Class: None Customer#: 5722274 Class: D CDL Permit Issue None Date: Name: Dumont, Dennis Charles Audit#: 1707445 CDL Permit None Expiration Date: Address: 2491 HOLIDAY RD Issue Date: 03/28/2017 CDL Permit None Endorsements: Expiration Date: 11/11/2020 CDL Permit None Restrictions: City/State: CORALVILLE, IA 522414705 Endorsements: Chauffeur 3 ID Status: None Mailing 2491 HOLIDAY RD Restrictions: Corrective Lenses, Left and DL Status: VAL Address: Right Outside Mirrors Restriction None CDL Status: None Mailing CORALVILLE,IA 522414705 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 11/11/1945 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Dumont, Dennis Charles DL/ID: 445AF9612 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver&Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver&Identification 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: ��EtST OF Tjq,ak o�QPa qo9� 5/10/2018 Q o *CD guig '-�l i .. .°72V-- — °�F, �� Driver&Identification Services —gc COAL DOC' Iowa Department of Transportation _� r. :<r" m Name: Dumont, Dennis Charles DL/ID: 445AF9612 (IA) — > GJ