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Home My WebLink About14-147 r Authorization Number I Li f 1 Li 1 (Office Use Only) 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.) ,lgwa City, Iowa 52240-1826 (31 9) 35 (319) 356-5497 FAX lrrst. cdl`(gr< La 1. Name I 2. Mailing Address i&ILS ' 0'191 - 12_ Cc•ckkA 1 is ;.Q qz2-tt1 3. Telephone: Home -3I9-432-cs95Y Other: 4. Prior experience in transportation of passengers: ( y-(,— ..1 - -I 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you ben convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /L✓L'} Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When Rte; tOryy 4 r-4ft s5A ( oF4Mc. i 4 W)5 /-2.1z_ co. , P �1ZLI/2 i 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /%'} 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) 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 cpifY that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I f 2-ZSGC{ ( . 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 Applicant Date 7 /-2-1-1/ 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 bylji---ey ? , ,1-p . On this cVLj4 j day of )u y. alAit WENDY S.MAYER /1A01-4-1,4-"A- P,-:" ,4-"A- Py commission Number 729428 l� A, rnmmis ion Expires Notary Public in nd for the State of Iowa oe+ -1 1-11-� ************************************************************************************************************************************************ 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). Ar Sig ture of. o_de 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. to of City C rk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/z"(width)and 5 '/z" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerI taxidrivbadgeapp2014.doc 03/2014 • .Jul. 2014 3:46PM Div of Criminal Investigation No. 5211 P. 1/4 v V.. IV. L V 1 7 1 V.-r V I V r I tiny V I y I V I l] VI t V n V V I I.] N N . 1,11 P I R/ L - „aFFUaL^ STATE OF IOWA - �,. ,„„ 'Cmnmimaalli lltory Neco d Cheek • ` i' : Y ,--?,:;.--,;:i. Reud� DfIl i ` Y • t 3` cann. 4007. — '' � DCI Account Number; `'t 0 0 7. — F (Irappltcable) To: Iowa Division of Criminal Investigation From: City of Iowa City . .. Support Operations Bureau, 1”Floor City Cleric's Office 215 B, 7111 Sheet 410 F.Washington Street Des Moines,Iowa 50319 (515)725.6066 Xowa City, IA 52240 (51 725-6080 Fax • Phone: 319-356.5041 Fan: 319 56.5497 I am requesting an Iowa Criminal History Record Check on: • Last Name (mandatory) First Name(mandatory) Middle Name(reccmrntndcd) • R; l.61 C r-c±' po,,-i_Y;(..‘C—• Date of Birth (mnridatory) Gender(nrando(ory) Social Security Number(recommended) O / d el / (' $ l IMMale DFebnale `1 VI 0 Li"26 2) . 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 waiver signature from the subject of the request, Waiver Release:f hereby give permission for the abovotegltesting official to conduce an Iowa odnllnd history mord check with ihcDiviston of Criminal lnvesagetion(DCI), My criminal history dela concerning ma that is ou'ualncd by the DClmay be released n aiiowca bylaw. . Waiver Signature; • Voltr,n. _ Iowa Criminal ,.i istory Record Che I le It : ,(DCIu56obi) • As of7 7 3 hi , a searoh of the provided name and date of birth revealed: Lo • _.... . 1 . .... . . No Iowa Criminal History Record found wit .DCI _` (((��- i CI Iowa Criminal History Record attached,ACI# DCI initials tif Received Time]'Jul. 18. 02014 10:47AM No. 5089` • ` .�► DOT SMARTER I SIMPLER I CUSTOMER DRIVEN — . _wwwiowadot.gov Office of Driver Services PO Box 9204 i Des Moines,LA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www,iowadoigov Certified Abstract of Driving Record Inquiry Date: 7/18/2014 DL/ID #: 811ZZ5041 (IA) Customer#: 2727263 Name: Riley, Bret Patrick Class: D ID Status: None Address: 1616 5TH ST APT 12 Audit#: 8167046 DL Status: VAL Issue Date: 06/14/2014 CDL Status: None City/State: CORALVILLE, IA 522411843 Expiration Date: 05/09/2019 CDL Cert Status: None Endorsements: 3L CDL Med Status: None Mailing Address: 1616 5TH ST APT 12 Restrictions: Corrective Lenses Restriction None Date of Birth: 5/9/1981 Supplement: Mailing City/State: CORALVILLE,IA 522411843 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 07/28/2009 08/24/2009 S92 Speed Buchanan IA 07/15/2011 08/15/2011 864 No Insurance Card Johnson IA 10/20/2012 11/15/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Riley, Bret Patrick DL/ID: 811ZZ5041 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: /o.`p0V>r111C1f 7/18/2014 10: IOWA e ff ►��yam:D. O. T. :>v' ciresin �_ Office of Driver Services �y�Of DIY Iowa Department of Transportation Name: Riley, Bret Patrick DL/ID: 811ZZ5041