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Home My WebLink About14-102 R Authorization Number 1 — 10 �- _ 1 (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (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,/iid le ast 1. Name e i ,it-cc(L 2. Mailing Address P-/ �� L4< 5fi . =� (- c)t.J�} Ci- s :)z<-1S ^ o� r q � � p 5� l� l ,a1' /� 3. Telephone: Home � � 4�b Other: 4. Prior experience in transportation of passengers: '1i i d T :ver /`-D i5 a 1-0,14Q,7- a 06 ) f i&s/rt 1 r 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 10 Type of offense Where When • 6. Have you beep convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 4)6 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? A_)0 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _4.) 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) 0 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) clerkftaxidrivbadg 03/2014 w , I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ICI iP / - e c-7 . 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 ith 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 foo; Date `� Z�// 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 [- .-p-c-Prp k) , ie---wr . On this 't-/A day of "4'4, WENDY s MAYFQ Notary Public in an or the State of low Lommtssion Number 729428 My Commission 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). , t(i( / ( I.( �i� Signa - i. Police Chief or designee Date YOU •RE 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. p-4r--rs_yam /! . 7 I " - /T Signare of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (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 o4Av.r. 2.1_- 20114;211: 35AM Div of Criminal Investigation : ' ., DCI Io!No. 5854 P. i/41 IC . r , . I , ' • • STATE OF IOWA , Criminal History Record Check . Inn r, • Request Form •I,., • DCI Account Number: 1{5f3-Fe- _ ��n (rrappfaewa) Tot Iowa Dlvbloa of Criminal inveatlgattoo From: y■•a 1-4.$1 5 Support Operations Bureau,l^Floor , I t. Slteylhs �r, • 2151.7°Street `, b - .. . _�1ea.M e*,.Iu1.S0519 -_-._.. . . • 00e—//��A,41,1-/ 5341-0 (SIS)7256066 •. (515)7256080 Fax • rheum IC 310 33F- ally• • Feat. • (3(4) SSI-87'91 1 am requesting an lows Criminal Histort Rccold Cheek on: - " Middle Name(mnme a alae) Lest Nettle essal raj) . First Name(,u&uon) K <2 GQ0FE(e - Eei Date of Birth t><+ >y)) Gender freivenn) •1 Social cuSecurity Number Otcon JC /2 0 (1-IT 7.5- IlMele Dvemele V 7 4 06 �C? Waiver Information;Without a eloped waiver tram the subject of the request,a complete edmlual history record may Dol be releuable,per Code of Iowa,Chapter 692.2.For yemol$te atm loot hbtory retard Information,u showed by law,always obtain a waiver aSCaature from the settled of the -i Nat. Waive,Release:Iharsygive pemWlonThr'k I../ row-loc(loW to m(owtdmralaim IdCheitMUticDfbimdoradml. Inratiption(Pcorm CI). Any minting biting deo nln gat 44 r Imdty lnay I fel n,d o dbond by law. . Waiver Signature: Ar /� ... __ _ .. _.-.____.._._..._. • L/Iowa Criminal History Record Check Results nwi.a.tar) F ;-, As Of "7 a</ f7 ,a search of the provided name and date ofbirth revealed: `ii :'; est-,) — --;•.'n (-) --n .r t No Iowa Criminal History Record found with DCI o t 0 Iowa Criminal History Record attached,DCI# -•'.', iv '" DCI initials • DCI.77(08/25/10) • Received Time Apr. 17. 2014 12:48PM No. 5619 Page 1 of 1 ✓ , • , vuww,iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 I Des Moines.IA 50306-9204 Phone:515-244-9124 I800-532-1121 i Fax:515-239-1837 www.lowadot.gov Certified Abstract of Driving Record Inquiry Date: 4/25/2014 DL/ID#: 196AD8857 (IA) Customer#: 3646257 Name: Kacer, Geoffrey Nell Class: D ID Status: None Address: 2110 N DUBUQUE ST Audit#: 7518587 DL Status: VAL Issue Date: 11/12/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 12/04/2018 CDL Cert None 522451624 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2110 N DUBUQUE ST Restrictions: NONE Restriction None Date of Birth: 12/4/1975 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522451624 History Information CLEAR DRIVING RECORD Name: Kacer, Geoffrey Nell DL/ID: 196AD8857 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: .tECIE ki . ..7� iy 4/25/2014 s VII. ,440a0****•C:ei Office Department Servicesrf Iowa Transportation Name: Kacer, Geoffrey Neil DL/ID: 196AD8857 4/25/2014