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Home My WebLink About14-111 41 Authorization Number ) 14 — ( 1 1 -' 1 (Office Use Only) int yeitib,_ C;t maIIIOw ialiN 'IR OU11141r 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 FirstMid e - Last 1. Name 44: ✓i 7 6A C 4Y ( r-� '�'1�r! / J / _ 2. Mailing Address 2_2_0 �� f6 ,�I.� r71` / 4 o�� 41 3. Telephone: Home ��// Other: 4. Prior experience in transportation of passengers: /447,1 5. Have you ever been convicted of anymisdemeanors and/or felonies in this State or elsewhere? `� lf � .-. Type of offense Where When -1°3 * 1/2 r/L�,e14/ex- (SLI/O: 17 wa( rt,f kr /2- 6. 6. Have you been 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? Type of offense Where When 2-o 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /t/ 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) clerWtaxidrivbadg 03,2014 • , I hereby, certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `/6 2-3Oe) . 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 _--_ :-•-) zr.— Date S /3 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 -e� . ,\ A C A . ,a ',,A vk . On this l 4 day of yVENDY S.MAYER 4, S Commission Number 729428 Notary Public in for the State of I a grAlIMIWallininlii ************************************************************************************************************************************************ 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). • / 51145/V Signature of Poli.- "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. %l a--' -E__6,..-4- i-e----- ---74( _ ---) -4,:e,':,',1.-- __z_.171__Signature of City Clerk or designee ate 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/taxidrivbadgeapp2074.doc 03/2014 . 4 p A Y '' tr D 4 , , . WWW.iowadot.gay SMARTER I SIMPLER I CUSTOMER DRIVEN - Office of Driver Services PO Box 9204 1 Des Moines,IA50306-9204 Phone:515 244-91241800-532-11211 Fax:515-239-1837 ww,v_iowadofgov Certified Abstract of Driving Record Inquiry Date: 5/13/2014 DL/ID#: 960ZZ3000 (IA) Customer#: 5150407 Name: Quinn, Devin Michael Class: A ID Status: EXP Address: 220 66TH AVE SW APT 5 Audit it: 5880541 DL Status: VAL Issue Date: 03/24/2012 CDL Status: VAL City/State: CEDAR RAPIDS,IA Expiration Date: 11/01/2014 CDL Cert Status: Non-Excepted Interstate 524045362 Endorsements: NONE CDL Med Status: Certified Mailing Address: 220 66TH AVE SW APT 5 Restrictions: NONE Restriction None Date of Birth: 11/1/1988 Supplement: Mailing City/State: CEDAR RAPIDS,IA Sex: M 524045362 CDL Medical Examiner's Certificate Certificate Specifics Explanations Medical_Examiner First Name _ --- _v� ___ ;Tracie .{ Medical Examiner Last Name iNeustel-Abbott Medical Examiner License Number ._._._.........______ - _. ..._......_. .__�._._._..__^p091593 i Medical Examiner Jurisdiction IA __.__ 1 Medical Examiner Phone ;(319) 356-3335 Medical Examiner Type Advanced Practice Nurse Medical Certificate Issued Date ;06/25/2012 Medical Certificate Expiration Date 06/25/2014 Date Added to CDLIS Driving Record 05/13/2014 CDL Downgrades Type Effective End ACD Issuing JUR Downgrade 104/21/2014 105/12/2014 , IIA , History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 06/12/2011 -:09/08/2011 F04 ;Seat Belt Violation Johnson ,IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 05/27/2006 'A61 Under 21-Alcohol Content.02 but less than .08 -:IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 106/07/2006 108/05/2006 A61 ;Under 21-Alcohol Content.02 but less than .08 11A IIA Name: Quinn, Devin Michael DL/ID: 960ZZ3000 ��o f pOe�C State of Iowa \N.4.it.or 10 ft, $`"v- �� s• Division of Criminal Investigation ` ,�,,,, `Icy 215E7tSt . " * + ,, 1;14: 7/ 3t u �. - C Y G ' IOWA Des Moines IA 50319 o,. 1 Ph.515-725-6066 Fax 515-725 6080 .:0A,* :��'"' 4,�k 5 ' i a i 9oFnoN Ptt Iowa Criminal History Record Check ,o � � Walk-In Request Your name ,f___ vrgt4 ,k„, Address % 26' 6-671 /lea 5 City/Statep 4 &4 Fill in all shaded areas. Phone# ,151_ 12---y/2/-a — 77 �4 J Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Printer Nombre(mandatory) Middle Name Segundo Nombre(recommended) tem Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number (recommended) / / / / 79n Male ❑Female %/,�-/5 —/ �_3� Waiver Signature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) Results I DCIUSEONLV As of 5\12\1 1 4 , a name and-date of birth check revealed: jaCrecord found ❑Record attached,DCI# DCI initials r---- Receipt Number of requests i x $15.00 per last name=Total amount$ ( 5, 0 0 Method of payment: Wash ❑money order CI check# ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number# Exp. Date