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Home My WebLink About14-209 Authorization Number �-1- _c -Ocf (Office Use Only) 4 IMES n III 'le All Ma I ART 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 �€irstMiddle 1. Name (REQUIRED) J C 6 '"-•-- 2. Mailing Address(REQUIRED) ( ( (0 11 l Gtr A UQ C S 2'7—'10 3. Contact Information (REQUIRED) Email: ) 4'� '7 i�( (. C-766.11 Phone: 21 36 /q/5 4. Prior experience in transportation of passengers: CC)(rJ' C ct t ( C ti,V21 ` at/L-- � S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? `) Type of offense Where When 6. Have yogi been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? !`J . Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? I C Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When .r- cn —r; .. ! 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro iihe name(s) tis z<� 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I X X 0 (7 5 . 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 o' e provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) t r / Signature of Applicant_ (;) Date ' I 1 / ----7' >/ 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 Ttl 5cl,,,t A- . C--ru}lhj.v . On this 1 1 day of Sa t'_34.Al ( ...21>i\-1- 1.}-)c). Notary Public in a for the State ofJbwa tal� WENDY C.MANTR r°,(%'*. r Commission Number 729428 . .. Co I on Expires 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). 4... , f-',7?' /'?, .2Q/K Sig atu e o Psir 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. .22C,~1z-•• -1.-/ - -eet.4....-y 6",_7,,,z _ • Signature of City Clerk or designee Date 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 Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 09/2014 IowaDepartment ! • Office of Omer`?ero (toil Free) 5 3 1121: PO 80X 91204.1JOs:Moines,LA 5030+5 9204 515-244-9124 f-e G 515,239,1837 Certified Abstract of Driving Record Inquiry Date: 8/18/2014 DL/ID#: 554XX0675(IA) Customer#: 1297025 Name: Grubbe,Jason Class: D ID Status: None Andrew Address: 1110 HIGHLAND Audit#: 4442439 DL Status: VAL AVE Issue Date: 06/17/2010 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 04/26/2015 CDL Cert Status: None 522402155 Endorsements: 3 CDL Med Status: None Mailing Address: 1110 HIGHLAND Restrictions: Corrective Lenses Restriction None AVE Supplement: — Date of Birth: 4/26/1960 c, rn " "J oa... Mailing IOWA CITY, IA Sex: NI —; 'l7 . n City/State: 522402155 ".. History Information --1c ., CLEAR DRIVING RECORD r-'� N ' =• w Name: Grubbe,Jason Andrew DL/ID: 554XX0675 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: _ ,[t pAAryP""/�I, 8/18/2014 41 IOWA'. (14 . Q. O. T. '* +k. .ails`° 0-''..,4"1' tali„�tl '4 �** 1. `'i,,c�-yfr' I ORO Office of Driver Services h '�k'cx,.�v--mo- Iowa Department of Transporation Name: Grubbe,Jason Andrew DL/ID: 554XX0675 0 OF Nog, State of Iowa OF. CJ, Division of Criminal Investigation 5 * �`� . 215E7thSt z'" '*. * Z° -5 IOWA Des Moines IA 50319 �c „sA,�,,��„ ,��,, y Ph.515-725-6066 Fax 515-725-6080 F'` .1.....*••_°*,a* Jy,_ AOC �Q `CRIMINAL S4 i/ON"�� Iowa Criminal History Record Check - Walk-In Request Your name _jA c' ,1 . ^ 41 ` Address + t---1; I 4 ="--4 l ' I'1 �l� h �� — ra® ^i'� City/State/Zip C 1 /L ``)7/_,--/- G Fill in all sh`aRQ‘i area$. Phone# 7f 6 — er 3 (; —( l S -� -v ll• • Wi=t I" il i !1) Requesting an Iowa criminal history record check on: C- Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) ,----1_ i Gr 1, \i(--) •_.-.)e (4- .-. 4-VV."( Date of Birth Fecha Nacinriento(mandatory) Gender Genera(mandatory) Social Securityl Number (recommended) r" c; ci /14 ( 1 , G 12:1-gate ❑Female Waiver Signature Firma(If the c(u t is on yourself,please sign. If the request is on someone else,write N/A.) J Results DCI USE ONLY As of q41 -19 , a name and date of birth check revealed: c;i4.No record found ❑Record attached, DCI# DCI initials , A- Receipt Number of requests I x $15.00 per last name=Total amount$ IS- Method of payment: ❑cash ❑money order 4check#39 1D ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials J &) Credit Card Number# Exp. Date