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Home My WebLink About15-019 ri Authorization Number / i> 1 C — 1 (Office Use Only) 7r~ 111 % APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday— Friday.) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First 1/0 ( a DT-�I Crud Ir) 1 lk a, n.),,u_e_ 7`—f- 1. Name (REQUIRED) � (Y��7 l l o 2. Mailing Address (REQUIRED) 11 ( 5 l 5 U Le 4\ 5 (: ��Q U U rrY+ 3. Contact Information (REQUIRED) Email:44/11 P N -71-4.1/a65'p�� .4h00"Ce11 Phone: -9 G- 62 2 / S/9 4. Prior experience in transportation of passengers: 5- 0 5 5 ce 9 5 ( 04/7t7 ti 4 r15 0 x- -k ti- � 5 U y-- i iv c, I( -e,/,-+5 FO 0 -.+i iia LI -F-e s e_ v o c-e a 0w { uC ( 4- JoiA) , r � 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elseyvhere2,, 'AD Type of offense Where A�!7-r-- -'34:,r„ iwno.J4�6; L L. , ` ^/morn 0,4 1. , 6. Have you convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? L) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? T e of offense _ Where . h,� When L,,--e_ . -}-q )"A I e N tV i 0 ( i�-+ION G'\ 1� 6- t b+��' I" - C- [ y OD- 0 / D 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 0 Type of offense Where When G'7 i 9. ,Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the narri9(s) .---.- DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED . ---7 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) 09/2014 I herey ce ify h I have iss d to me by the Iowa Department of Transportation a valid Chauffeur's license number D ( f f 0 > . 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) p QSignature of Applicant U k Date 0 1 .- -,3/D_O L.,5 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by yV( d.-t_cl ,Q0 C-, .T1nin .Q . On this a - ic-CI day of .5c .\1.1�c Gf.-y �1`J ( ��QI,�P _ a A.Cli Q fQ�\ mei Public in and ff r the State of Iowa ( � • i .Wiliglia. 7 * k: 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). V2i5/ ._ /5 Signature of Po e [lief or designee Date YOU ARE NO 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. Pie.e.f. „„) k ., -....z' '/� 3 (s Signature of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (width)and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXIDRNBADGEAPPL92014amended.DOC 09/2014 - Jao. 16. 2015- 3: 19PM Div of Criminal Investigation No. 8263 P. 1/4 JdFI. IJ. LUIS t2: tn�1 �tty �terK — pity of sorra Lilymo. )7)y r. i th�nrFI/E _ =Lis'r;, STATE ® JVl � � 111Q74',:-7 ! Criminal History RecordCheck . ;afk',� , 7 ,. : • DCI Account Nmnbei: 40O' ...-- F Of applloabio) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,VI Moor City Cleric's Oftico 215 E. 7i1'Street 410 E.Washington Sfteet Des Moines,Iowa 503'9 (515)725-6066 Iowa City, TA 52240 (515)725.6090 rex Phone; 319-356-5041 igp . , Fex; 319356-5497 I art requesting an Iowa Criminal History Record Check on; _ La 110 uandatery) Milt Nati ie(mandatory) Middle Name(recommended) 1e— IN1V`e. fit • VIA t/INPA‘t tO‘e-V-ii 1 k 1 Date of Birth(mandatoo Gender(msadolor)) Social Security Number(recommeadcd) CA a I V , J ®MaIe 0Female l tJ I ( 4' b / fiO Waiver Information:Without a signed waiver from the subject of the 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 Watt'ersi•nature from the sub tot of the rel nest. Waiver.Relerrse;l hereby give permission for the above re uosdng official to conduct an Iowa eriminia history record check with the Division oCCrltp*WI lnvestlgatlon(DCI). Any criminal Kt tory data concemins me at to ma tamed y the DCI may be released as allowed by law, _ Waiver Signature: t —5.--- fv ' JLowa Criminal HIstory Jee2 s Check Results (DCi ueonly)._ As of 1 \(a \) , a search of the provided name and date of birth revealed: . p-1 No Iowa Crirninal1LIistory Record found with DCI 0 Iowa Criminal History Record attached,DCI# bCIinitials Received T i me—Ja n; 15.,;,2015-12:48 PMJNo. 8877 ^, D SMARTERf SIMPLER I CUSTOMER DRIIVEN t4 ww iowadot gov Office of Driver Services PO Box 9204 Des Moines,lA 50306-920:4 Phone_515-244-912418G0-532-1121 t Fes:515-239-1837 wvuve_iowadotgov Certified Abstract of Driving Record Inquiry Date: 1/15/2015 DL/ID#: 109AA4183 (IA) Customer#: 1105753 Name: Bennett, Michael Gerald Class: C ID Status: None Address: 451 S SCOTT BLVD Audit #: 6636325 DL Status: VAL Issue Date: 01/23/2013 CDL Status: None City/State: IOWA CITY, IA 522455526 Expiration Date: 08/22/2017 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 451 S SCOTT BLVD Restrictions: Corrective Lenses Restriction None Date of Birth: 8/22/1963 Supplement: Mailing City/State: IOWA CITY, IA 522455526 Sex: M History Information Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/02/2012 706556 IA Name: Bennett, Michael Gerald D!/ID: 109AA4183 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: v�tClf Oer" .... h 1/15/2015 IOWA 'S Si,D. O.T. e% 64001/4::&4" 0819ER..... . Office of Driver Services Iowa Department of Transportation Name: Bennett, Michael Gerald DL/ID: 109AA4183 rri • f.T}