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HomeMy WebLinkAbout18-071�r+AMP,"It i .... III�- �►-®�4� CITYF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO. (Office Use Only) r APPLICATIISN 6 RAJNGAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department IIr''eview must be (made between 8 a.m. to 3 p.m., Monday — Friday) Failure to cor 19IJY27eabPePi�formation will result in denial of the application CITY CLERK OVA CITY, 10'-' First _ Middle 2. Address (REQUIRED) P.O. 1.n 3. Contact Information (REQUIRED) Email: (AII wrifterf comm 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) \-I 4 5. Prior experience in transportation of passengers: /1 Lo ox L-�> Cell Phone: tion sent via email) Iq *t/l/J -amu U S Z+SS -93 u -© q33 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? 1\1 t'? Type of offense What happened to the charge? (Circle one) Where When r - /v i, Convicted Dismissed Deferred Suspended Plead Guilty Other ) rzctjj 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? W Cp 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STERIIF D DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLI EFiRWrW You must apply for an individual Department of Criminal Investigation Report (form available upon request). 2018JUL 27 AM 8:45 CITE' CLERi iO!" A C T1 I ,... I hereby L�t�l have iyp�Q�to me by the Iowa a m nt of Transport ' a Calls D. vi§rs license number issued on expiring on ZS I understand that if I falsely answer any questions in this application, that this app ca ion may be denied. I agree t at 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions , hapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date lb STATE OF IOWA ) COUNTY OF JOHNSON ) S.qbscribed and sworn to before me by on this day of -21V aat�A Nbtay Nblic in and for the State of Iowa '1 (3110 I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date or -9 7 8-Z3- Zr 7._ 2 &-/d Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. or de nee U Date Office Use Only Approved application DCI report State certified driving record Website update awkNAX1DRN DGEAPK92o19eman .[>oc 0412018 ARTS C,JIOWADOT FUE-D SMARTER 1 SIMPLER I CUSTOMER DRIVEN wwwJowadot. OV a lirrbas PO Box 92041 Des MoOM 14 503089204 Phone: j rAC 515-239.1837 C1; i, '.. Certified Abstract of Driving Record Inquiry 5/31/2018 DL/ID #: 428XX5189 (IA) CDL Permit Class: None Date: Customer #: 4327574 Class: D CDL Permit Issue None Date: Name: Fowler, Eric Dean . Audit #: 2020491 CDL Permit None Expiration Date: Address: 122 1/2 N DEVOE ST Issue Date: 08/02/2017 CDL Permit None Endorsements: Expiration 08/23/2025 CDL Permit None Date: Restrictions: City/State: LONE TREE, IA 527557742 Endorsements: Chauffeur 2 ID Status: None Mailing PO BOX 33 Restrictions: Corrective Lenses, Left DL Status: VAL Address: and Right Outside Mirrors Restriction None CDL Status: None Mailing LONE TREE, IA 527550033 Supplement: CDL Permit Status: ELG City/State: Date of 8/23/1973 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Fowler, Eric Dean DL/ID: 428XX5189 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification 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: yEN� O 5/31/2018 3� At�1�6-)L Ac�-eb- Driver & Identification Services omi oocu`� Iowa Department of Transportation Name: Fowler, Eric Dean DL/ID: 428XX5189 (IA) 5/31/2018 Jun, 1. 2018 8:36AM_ Div of Criminal Investigation No. 0114 P. 1/1 . wr.. —.•r lurk .-,_ ,-----e. 00/01/2010 00:ee —630 STATE OF IOWA 2016 JULCiT" � Criminal History Record Check 27" Request Form,.,, � C „- To: Iowa Division of Criminal Investigation Support Operations Bureau, l" Floor 215 E. 7f' Street Des Moines, loo's 50319 (S15) 725-6066 (515)725.6080 Fax I ant reeuestine an Iowa Criminal l4istnry Rernri r'hnAlr 0. - DCI Account Number: 14 - From: City of Iowa City City Clerk's Office 410 E. Washington Street Iowa City,IA 52240 Phone: 319-356-5041 Fax: 319.156-5497 Last Name (mandatory) / _ First Name (mandatory) Middle Nameyetomrended) Date of Birth (manila on) Gender (mandatory) Social Securi Number (mwmma,aee) 3 -1 � ale ElFernale 5 �. 3 � 3 talways Waiver Information.- Withouta signed waive• Rom thesubject of the request, a complete criminal history recorbe releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Infmtnation, as allowed byla obtain a waiver signature from the subject of the request. Waiver Release: l hereby give permission for the above reqursling otfiefal to conducts& lout& criminal history record check with the Division orCriminal lnvallgation(DCQ. My criminal history date wnceming me shat is maintained by lho DCl maybe released as allowed by law. 1' Waiver Signature: ���~ a �r Iowa Criminal History Record Check Results As of lD -H .12 , a search of the provided name and date of birth revealed: 4 No Iowa Criminal History Record found with DCl ® Iowa Criminal History Record attached, DCI DCI initials UCI-77 (06/25/10) Received Time Jun. 1. 2018 8:04AM No, 9823 (DC] use only)