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Home My WebLink About18-097I Qin®f1�� •�rrll®��il CITY F IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED) 6' IDENTIFICAT,,�N N�i (= e Use Only) N n � z APPLICATION FOR TAXICAB I MOTORIZED PEDIC),W VE1PCLE DRIVER (Police Department review must be made between 8 a.m;36-3 p.a►., Monday — Friday) y� w Failure to complete the "required" information will result in denial of the application 3. Contact Information (REQUIRED) First Email: ��, Y MAl.3c7 SLG �C (All written communication sent via email) 4a. Drivers License expiration date (REQI b. Taxicab Business Name (REQUIRED) Middle Phone: 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged With any misdemeanors and/or felonies in this State or elsewhere? o Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? 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) %' D (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 t 1 ' tl APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I h!= cert' that I have issued to me by the Iowa epartment of Transportati n a valid Drivers license number Lj �� N. issued on (_# expiring on 1 . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisigp of Title 5, Chapter 2„pf the City Cp*. (Needs to be signed in front of a Notary Public) Signature of ApplicantWWI(�/lOn Qui Date o I a«aaaaaraaaaawaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaawaaaaaaaaaaaaaa+aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaraaaaaaaaaaaaaaaaaaaaaaaaaeaaaa STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn 1p before me by 7WIL �-t iAQwC,-f___J on this Q_ -LM day of cn Notary Public ild and for these $ to ofTbi06a� M ................. ....._........._---------------- I have reviewed this application, DCI report, and the State certified driving record of this applicant fii7tJ have_]aetermined 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 of Driver's license �0, / qcl Sign re is hief or designee l /2OIIB 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. Si ature of City Clerk q designee Date aaaaaaaaaa+aaaa+*eaaaaaaaar�raaaaaaaaaaaaaaaaaaaaaaaaa:aaaawaaaaaaaaaaaaaaaaaaaaaaaa:eaaaaaaaaaaaaaeaa+eaaaaaaaaaaaaaaaaaaa:aaeaeaaaaaaaaaaaaaaa Office Use Only Approved application DCI report State certified driving record Website update CIWWTAXIDRNenocen 92oi�.DOC 04/2018 WENDY S. MAYER 0 rawl My mf ion Ezplres 7WIL �-t iAQwC,-f___J on this Q_ -LM day of cn Notary Public ild and for these $ to ofTbi06a� M ................. ....._........._---------------- I have reviewed this application, DCI report, and the State certified driving record of this applicant fii7tJ have_]aetermined 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 of Driver's license �0, / qcl Sign re is hief or designee l /2OIIB 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. Si ature of City Clerk q designee Date aaaaaaaaaa+aaaa+*eaaaaaaaar�raaaaaaaaaaaaaaaaaaaaaaaaa:aaaawaaaaaaaaaaaaaaaaaaaaaaaa:eaaaaaaaaaaaaaeaa+eaaaaaaaaaaaaaaaaaaa:aaeaeaaaaaaaaaaaaaaa Office Use Only Approved application DCI report State certified driving record Website update CIWWTAXIDRNenocen 92oi�.DOC 04/2018 Sep.1/,2018 3:32PM Div of Criminal Investigation 09113/2018 10:04 Yellow Cab STAT V OVTOWA. Crimi"I H28fty Rocard Check RequmfFarm To: OVVR `S RFa�SriDE'cetiutis e"44 I* Floor Ow NOW% idwa 0319 (11101 096, Fax No. 4976 P. 1/2 fAX)319 330 2708 _.P.0021002 rj I 0 - IV, Cn 15CI:AOOOtmt Number, —W74 pr4w. Cab VUOWR elry ,TA. 9144 (319) 3AS-9777 pitV, (210) 33.9--73M ani an 10MM # jml R!�k*j: %r er6pw=w&4 0op /0 Cq1. OX410 ElAftale 0 4 0 Wall 777��: Ww %me barejesubl'R11 'Lo4eoYloei�Chaptrr`6R22Bvica 4 %*r lidonjaea9onedbylaw,aiways ftguest. W, %.Iowprp*- dM �i. wfth1Ml*wmOyQ1Mhw As of Ot1 A seaxa.-Ofthe provil3ed n&Mb%44d date of 6* LOVC4W. N0 Iowa Cz4miad]i Xory Record found with DCI ❑ 10wat$!MinW Hi--tOrYRecOr4=6trd, DCI-* DCf Wtiel OXI an 4WY) rj I - IV, 5eo.11.2018 3:32PM Div of Criminal Investigation No.4016 P. 2/2 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to obtain this Information from the Division of Criminal Investigation. In order to request the release of confidential juvenlle records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: htto://www.lowasexoffender.com/. However, even though some Information is available on this site, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential Juvenile records, if any, an application must be flied pursuant to Iowa Code section 232.147(18). N m O m N rnN �r i�' C Ao"-j 14,10WADOT .la,a a SMARTER I SIMPLER I' CUSTOMER DRIVEN.� orhw & Ide/HMicatloa SM'[OeS PO Box M i On Moines. IA 5d9WM phone; 515-747-91241 Fag. 5f$-2,19.11ss, Certified Abstract of Driving Record Inquiry Date: 9/13/2018 DL/ID #: 993AM2880 (IA) Customer #: 4666010 Name: Mandell, Jeremy J Class: C ID Status: None Address: 1111 DOWNEY DR Audit #: 9932880 DL Status: VAL Issue Date: 04/13/2016 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 06/19/2021 CDL Cert Status: None 522406033 Endorsements: NONE CDL Med Status: None Mailing Address: 1111 DOWNEY DR Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 06/19/1973 Mallin g IOWA CITY, IA Sex: M City/State: 522406033 History Information CLEAR DRIVING RECORD Name: Mandell, Jeremy J DL/ID: 993AM2880 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of 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: Name: Mandell, Jeremy J DL/ID: 993AM2880 9/13/2018 Driver & Identification Services Iowa Department of Transporation