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Home My WebLink About14-197 r Authorization Number ) — f q -7 1 (Office Use Only) rte'''®�aillr APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday— Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name -11 ,‘ e 5 -eVC'150--� 2. Mailing Address // 5 S r~ Sr (4)Q.5 ,5- 3 ' 3. Telephone: Home 3M-3 3 t -'03 2q Other: 4. Prior experience in transportation of passengers: .! L..,,t ,`� 0-J— (, -J--(, 4) 5, /\ -7„OrJ I 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? l r S Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /1 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? (1 L - Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? i'I 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) /1D 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) clerk/taxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �55XX 5`f Q "f. . 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) C� (� Signature of Applicant 7«4..___, - Date / /r f 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 'T amu, el) L q j�sa,^ . On this ,24-(--1,\.. day of AAIlav4a_4r .V-Oi4 . it At WENDY S MAYER \� ] ` � ,Y 0• Notary Publi and for the State of lo5�ia . t. .. r`nmmigstn�Numbe 29428 • ;_j, • My Commission xPires tow "1-/1‘-I LO. 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). ; q (z/(y Sigr{atu�e of Police Chief or designee Date J 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. Signature of City Clerk or designee Date 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/taxidrivbadgeapp2014.doc 03/2014 :Aug. 27. 2014 4: 29PM (Div of Criminal Investigation NNo. 8696 PP. 12 • STATE OF IOWA • . ,�:g",. Aparay rm ,;` Criminal History kecoS Cheek 2 r,, °.�,': 'r.'44/ • Request Form F. .-' o>rr�. \-niun:ieser t • ijr)eci r DCX Acoount Number: 900,,--r--- (Ifeppltotbl4) To: • Iowa Division of Criminal Investigation From: City of Iowa City • Support Operations bureau,1"Floor City Clerk's Office • 215 B.71h Street 410 R.Washington Street Des Moines,Iowa 30319 (515)725-6066 Xowa City, TA 52240 (515)725-6000 Fax • Phone; 319-356-5041 • Vag: 319 356.5497 • I am requesting an Iowa Criminal History Record Check on: • Last Name (mandatory) First Name(mandatory) `Middle Name(recommended) siever) 50/N D,.�, e( Bcif,I- f Date of Birth(mendetory) Gender(mandatory) Social Security Number(raeommanded) LCJ 7 (?0 /7 7 Ariale Oremale 3q 3°— 16)--7-670 Waiverl'nforsnation: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 waiver signature from the subject of the request. Waiver Release:Thereby give permission foram above requesting official to conduct an Iowa criminal hisloryrecord check With the Division of Criminal Investigation(DCI). Any criminal history data concen)in • le hat is ma"mined the DG may be released as allowed bylaw. Waiver Signature: LAS t.tAt Iowa Criminal History Record Check Rondo (DCI.use only) As of qi 'd-n1 Li , a search of the provided name and date of birth revealed: ..• :y kNo Iowa Criminal History Record found with DCI • .!:• _ • •_.. .. . • • •• 0 Iowa Criminal History Record attached,DCI# -" ta DCL initials V'1 Received Time7'Aug. 21. tC2014 4:34PM No. 8077 IowaDepartment of Transportation in Office d Driiveruelvir (Toil Free)80a-532-1121 set PO Box 9204,Des Wines,LA 50305,9204 515-244-9124 FAX:515.23x]•1837 Certified Abstract of Driving Record Inquiry Date: 8/29/2014 DL/I D #: 555XX5497 (IA) Customer #: 1217962 Name: Stevenson, Daniel Class: D ID Status: None Barratt Address: 115 N 5TH ST Audit #: 4518598 DL Status: VAL Issue Date: 07/16/2010 CDL Status: None City/State: WEST BRANCH, IA Expiration Date: 07/20/2015 CDL Cert Status: None 523589615 Endorsements: 3L CDL Med Status: None Mailing Address: 115 N 5TH ST Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 7/20/1977 Mailing WEST BRANCH, IA Sex: M City/State: 523589615 History Information CLEAR DRIVING RECORD Name: Stevenson, Daniel Barratt DU ID: 555XX5497 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'YLFlea O 8/29/2014 1 ,.•u•••_p../f irs e� 11 ,��yy T Y k Ahy �` ( ,fir' Office of Driver Services Iowa Department of Transporation Name: Stevenson, Daniel Barratt DL/I D: 555XX5497