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Home My WebLink About14-039 Authorization Number 1,�i 3 Q 1 (Office Use Only) APPLICATION FOR TAXI 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 )v;)�� F. ' " L ., r-. 2. Mailing Address `� ' ' ' '- 3. Telephone: Home \ 3 33 b`t 4S� Other: 4. Prior experience in transportation of passengers: \<.) GwP_ �,e -�e�� 1)t),-.) CA 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? eS Type of offense Where When a J.-. l 1 c{ci 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? NJ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ' c) Type of offense Where When N� c- +\ Q.e s;r�y,; C-4,»11Q, -51 1 \-3 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ni 3 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) o 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 03/2013 w I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ,o y� C,�ssvy . 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 l'au Date j Z17-5 1 t4 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by N 1---t-cc, A .0.i y . On this day of az . .� rR NDY S.MAYER .mm,ssien Number 725428 Notary Public in an for the State of low 10 ******.*************************.*************************************************************************************************************** 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). 0.2/.2S* Signature of Police 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. 4.r../t2 .91a/5//11 Signat of 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 clerkftaxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation «• Office of Driver Services (Toil Free)800-532-1121 PO Box 9204,Dec Moines,IA 5030&-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/4/2014 DL/ID#: 608YY6801 (IA) Customer#: 2110531 Name: Kaim, Nikita Andrei Class: D ID Status: None Address: 716 N DUBUQUE ST APT Audit#: 7118031 DL Status: VAL 84 Issue Date: 07/10/2013 CDL Status: None City/State: IOWA CITY, IA 52240 Expiration 11/18/2018 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 716 N DUBUQUE ST APT Restrictions: Corrective Lenses Restriction None B4 Date of Birth: 11/18/1973 Supplement: Mailing City/State: IOWA CITY, IA 52240 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/08/2013 04/08/2013 F02 No Child Restraint Johnson IA Name: Kaim, Nikita Andrei DL/ID: 608YY6801 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: OFF way . t. . i'4 2/4/2014 IOWA Telt. D. O. T.• ,IIcs • ''eOf� `-sein Iowaee Departme teofcof Driver lTransportation Name: Kaim, Nikita Andrei DL/ID: 608YY6801 Feb. 21. 2014 2: 19PN Div of Criminal Investigation No. 35361 P. 1/5 fl., U. fr. to! l4 Iv,PI rill of rY vt UIn vl ly vi Iuwa I.,I Investigation, IYu. '}Jyy r, • ' ` STATE ® 'IOWA �,.,..r., I Or 't \'' Crriimmiunall]HIi tory Revord Oi eek t i4F a ,. ,. ,,^..I J.. ][BtEQ�IlOeffitf lP'®sunn a:., L just e. D Account Number: 1./00..1 /� (It ppltcablo) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,1stFloor City Clerk's Office 215E,7ih Street 410 E,Washington Street Des Moines,Iowa 50319 (51S)725.6066 Iowa City, IA 52240 (515)725-6080 Psi Phone: 319-356.$041 • Ps>t: 319-356-5497 X am requesting an Iowa Criminal IlistoryRecord Cheek on: . Last Name(mandatory) EirstName(mandaary) Middle Name(rewmmeadcd) It-0.1N\ NI lc, tknre,1 Date of Birth(mandawry) Gender(mandatary) Social Security Number(recommended) 11 -106- 73 - Male ®Female 11g0 4< ss .-7SU Waiver Information:Without a signed waiver from the suhJect of the request,a complete criminal histo y record may not be releasable,per Code of Iowa,Chapter 692,2.Fpr complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request, Waiverl?elease:IherebyglvepermI$sIole for the oboya requeetingofflciel Co umbel an Iowa criminal history record chcckwith do Division of crlminal tnveellgatiou(DC]). Any criminal hlslory date concealing polaMat Iss�mainialnedbythmDCI meybereleased asallowed bylaw. 4t,/Waiver Signature: �t„HNc • • Iowa Criminal History l''eeord Cheek i''egvilt� (Dotusoonly) 2121\�� -_ -ri As of ,a search of the provided name and date of birth revealed: "- -� `" n1 C1 W I cn — 1.3tTi 8 No Iowa.Criminal History Record found with DCI -�'c' `O : Feb. 21. 2014 2: 20PM Div of Criminal Investigation No. 3536 P. 2/5 • IOWA CRIMINAL HISTORY DCI 00441486 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2014/02/21 DCI:00441486 NAME: KAIM,DAN KAIM,DANIEL P KAIM,NIKITA ANDRE/ DOB SEX RAC HOT WGT EYE HAIR SKN POS 19731118 M W 507 201 BLU BRO PAR FL ADDITIONAL IDENTIFIERS • TAT LF ARM CCH RECORD +•+ 01 ARRESTED 1999/024 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708-1/236-2 DOMESTIC ASSAULT W/INJURY TRK#: 035763401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING CHARGE CLASS: NON CONVICTION TRK#: 035763401 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20000218 COURT COSTS 20000218 PROBATION 1Y 20000218 • DISCHARGED FROM 20000918 DEFERRED JUDGEMENT AN'ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED EY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OP FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT TAE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION