The URL can be used to link to this page

Home My WebLink About14-086 Authorization Number /6/ - Scio 1 (Office Use Only) �III � 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 Middle Last , I 1. Name / A i- r e ' �(�� /e t°e 1� a r Cl i'k A 2. Mailing Address .2 9/V LT S t, S W . 1/L N (l 1} Pi`c)S IA 59 V 3. Telephone: Home .q/9 3 2 91'05 Other: ,�/� 4. Prior experience in transportation of passengers: ,t«r�� 3tel/ -d �l�Z�-Cti� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ,24 Type of offense Where When 6. Have you een convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When (Th-et 2.1'w Z44 . , 1tM P R 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 92e) 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) ��, 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 2/) 7 V.0 O G . 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 �p/}��r ,�` f i�r� Date � t'- / 'i' 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. *******************************************************************************************iv**************************************************** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by M , - . . ! On this LI- Ltti, day of Arc; L a-o1 - _ r _ 77, WENDY S MAYER otary Public in :nd for the State .i Iowa 11 i.° , Comrllsswr Number Z29"28 4' i ' My Commission Expires ow _ ?-11-/ Le ************************************************************************************************************************************************ 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). � I Z/ Z./ Sign7-1(oc='Cr efi•esignee 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. -)/ LIII-4- -/--z k - zti� `� '/' ---- 4 Signature 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 clerlJtaxidrivbadgeapp2014.doc 03/2014 • fkWs VVVVAN.10 waClot.gOV SMARTER I SIMPLER 1 CUSTOMER DRIVEN Office of Driver Services PO Box 92041 Des Moines,1A 50306-9204 Phone:515-244-9124 1800-532-1121 1 Fax:515-239-1837 www.iovradot.go°: Certified Abstract of Driving Record Inquiry Date: 3/27/2014 DL/ID#: 327UU8600 (IA) Customer#: 447773 Name: Dietrich, Darren Lee Class: D ID Status: None Address: 2414 J Street Sw Audit#: 6805551 DL Status: VAL Issue Date: 03/26/2013 CDL Status: None City/State: Cedar Rapids, IA 52404 Expiration Date: 03/24/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2414 J Street Sw Restrictions: Corrective Lenses Restriction None Date of Birth: 3/24/1936 Supplement: Mailing City/State: Cedar Rapids, IA 52404 Sex: M History Information Convictions Citation Date _ Conviction Date ACD Explanation County JUR .05/07/2009 :05/12/2009 X592 Speed (10 mph 8g.under in 35-55 mph zone) Clayton dA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Casa Number JUR 11/21/2005 5258041 IA Name: Dietrich, Darren Lee DL/ID: 327UU8600 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: #-• ""••., Iy 3/27/2014 IOWA o s D. O. T.,' ,,,I I�O,OBVE&S �i \, Office of Driver Services Iowa Department of Transportation Name: Dietrich, Darren Lee DL/ID: 327UU8600 i▪■ Apr. 3. 2014 3:36PM Div of Criminal Investigation No, 6619 P. 2/5 mai, Jl, GV ii It.ill al •,. Ily ,.laic — lolly UI Iowa lolly ; No. 49Dd P. I ■ INN 1 III - . • 1 In ■ ■ , .r;,,:c� vur , STATE OF I(i.WA 0,/,, ,, i`r L;1 e . ,adP,n):>);1 Criminal �istox r Record Check ' '.. x., , \�'l'—irl A 4 Roir;oiciequest Form ` ;J Eggeo ' DCT AccountNumber: CFO 03."'F' (if applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,1"Floor City Clerk's Office 21SE.711'Street 410 B.Washington Street , Des Moines,Iowa 50319 , , —. (515)125.6066_ __.. ___ . Iowa Clty, IA.52240 • __., __ ___ (515)725-6000 Fax Phone: M9-3S6-5041 Fat319-356.5497 ' 10.`4i Iain requesting an.Iowa Criminal History Record Check on: Last Name (mandatory) First Name(ntanda(ory) Middle Name(recommended) DI c if- i•c k 04- Pt eM I_ e - Date of Birth (mandatory) Genrdeerr((mandaray) SoDiaalSecurity Number(recommended) 8 - a 3 male ❑Female Y V3 - °Ya- 7'23 / Waiver Information: Without a signed'waiver from the subject of the request,a complete criminal history record may not Do releasable,per Codo of Iowa,Chapter 697.2,For complete criminal history record Information,as allowed by law,always • obtain a waiver signature from the subject of the request. Waiver Release:thereby gib;Fermis sion for the above runt eating°Mid to conduct an Ion criminal his[my record altar with the Division ofCrinsinnl Investigation(DCI). Any criminol history data concerning me shat Is maintained by the DClmoy bo released as allowed by law, Waiver Signature:. 4 ''n irat_• • • Iowa Criminal History Record Check Results , .0blusfal,y) ,;, As of 1A -6I111 a search of the provided name and date of birth revealed: r-+'•�' '" •l: .i GJ 17177 pi No Io'tva Criminal I•Iistory Record found with b CT _i_; -f' ,._ ® Iowa Criminal Sistory Record attached,DCI It • • DCI initials 1. -- --- • Received T me7'Mar,31,22014 12:30PM No. 3602