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Home My WebLink About14-255 I' Authorization Number 1 = 1 /(Office Use Only) ------......m.:::®ter ". wrwI:i CITY OF IOWA CITY APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (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 Middle ast .--)::A-----0—\—. 1. Name (REQUIRED) �co.v`. \-,c->./c,,,+- 2. c-/c,, ,+- 2. Mailing Address (REQUIRED) (70 t,z...r.- -'> /s i 4/S IC.-L;(1_ Cd�j TA 3. Contact Information (REQUIRED) Email: 101^c=.�wrt- hrykr-1—i�tv�_C6,y Cell Phone: 3/i 13c'' 8853 6 V 4. Prior experience in transportation of passengers: t (..K e . 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where lei ,„,moo I 6. Have yot be,n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five Nyears? I ' Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ///A- Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /V4- 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) 4//A DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW a You must apply for an individual Department of Criminal Investigation Report(form availab1 upon}request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) ' c.,) 4,.,,.t crt 09/2014 a I h.greloy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number "iii6 46 '70 . 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) ] Signature of Applicantr-�_ �� — Date 1 /Zi /G/ 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 i -,ra i , ► � S CAUL t . On this 7) day of A ,72t)/. fAl 729428 Notary Public irg,,hnd for the State of wa 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). l�zv Signature pfi olice 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. //t;/II / K Sign ire of City Clerk or designee Dat 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 ClerkdTAXIDRIVBADGEAPPL92014amended.DOC 09/2014 WNW,i(ma dot.gov SMARTER I SIMPLER I CUSTOMER DRIVER Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 i 500-532-1121 l Fa.x:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 11/15/2014 DL/ID #: 496AG7609 (IA) Customer#: 5794600 Name: Bryant,Joram Beau Class: D ID Status: VAL Address: 1205 LAURA DR LOT 15 Audit#: 8600597 DL Status: VAL Issue Date: 11/07/2014 CDL Status: None City/State: IOWA CITY, IA 522451528 Expiration Date: 08/09/2018 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1205 LAURA DR LOT 15 Restrictions: NONE Restriction None Date of Birth: 8/9/1993 Supplement: Mailing City/State: IOWA CITY,IA 522451528 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 09/10/2013 756655 IA Name: Bryant, Joram Beau DL/ID: 496AG7609 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: �t1 z,f g0 ,/��4 11/15/2014 t IOWA 44,14 eiegfeipezi4 %:.D. O. T.: ®f'Od111Ea g' – Office of Driver Services �..„.,• Iowa Department of Transportation r� 7 J y C> N r""'=" Name: Bryant,Joram Beau DL/ID: 496AG7609 - — t 'r, --p m c,.) ' Cfl Nov` ' 1b8. 2014 11 : 30AM Div of Criminal Investigation NNo. 4363 FL P. 1/1 flv1. IJ. LV IT JI J 41111 Uity vIGII1 vI vi Ivlra VI . ■ `SM Of l'il!'VL` STATE OF IOWA Lel . kvt, 0 �i ord Check :$ - � �,3 Criminal History �'ec �: :' 1 7. 1-'- zi Request Form • : ,,, • DCI Account Number: (If applicable) To: Iowa Division of Criminal Investigation Prom: City of Iowa City ' Support Operations Bureau,1"Floor City Clerk's Office , 215 E.7111 Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, L& 52240 (515)725-6080 Fax - >'Jton e: 319-356-5041 Fax: 319.356-5497 •I=requesting an Iowa Criminal History Record Check on: _ Last Name(mandatory) First Name(mandatory) . Middle Name(recommended) V J CyCL A4--- "a I a vt'L \'Sect.1.),.. Social Security Number(recommended) Av, A- qtA m3 tA.S S7W- Z'S---" 2ZIS complete , r 1 IIIIIIIIIIIIIDate 11 r r r ► . Waiver Release:I booby give permissfon for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Tnvettlgstion(DCI). Any criminal history data concentingmc shat Is maintained by the DCI maybe released as allowed by law. c.,s.e/f./LAy Waiver Signature. • -_- /"r._ S Iowa Criminal History Record Check Results ___. Anseonl As of. IIs lel ti , a search of the provided name and date of birth revealed: c)....7,:,, iZ = ic- `;r —i- M - No Iowa Criminal History Record found with DCI c.,:..-`' t,.•? 0 Iowa Criminal History Record attached,DCI# _ '• • ' DCI initials Received Tiiri7e7Nov, 1 1'1(2014 3: 50PM No. 3998 -