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HomeMy WebLinkAbout18-113� r 1 CITYF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Last r' 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. (Office se Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the application L 3. Contact Information (REQUIRED) Email: 4a. Drivers License expiration date (REQUIREWD) b. Taxicab Business Name (REQUIRED) 1 � 5. Prior experience in transportation of,passenge First Middle t:�v / (-r a rSJ� Z E/ Z-1-yn �mu - 60— Cell Phone: written communication sent via email) 2-18"-joZs 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or els here? ,/I/' P Tvce of offense Where When—, —� x, 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? AtZ& Gy o Type of offense Where When ©�1?ozl,W, C� l� X -off What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspende Pile Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the years? A-) !�) 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) AV J (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2: DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTMD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upoWrequest). I hereby cert' -L% 1ae-5 that J nave issued to me by the Iowa Department of Transportation a valid Driver's license number cJG �/ issued on t / expiring on 2C>Z3. I understand that if I falsely ans r n questions in this application, that this application may be denied. I agr a 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 agreet, if authorization to be a taxicab driver is granted, to comply at all Ttimes with all of the pr4vistons Title 5, Chayter , o th City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant J Date Z� 2 Of D STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 71DcknAeN L on this �r- day of D�U_'_(Lo f Z .-„n _ and for the $tate of Iowa ��� 1�4ftMR1e/lMHetll4tFftf4M!!1'kRl4f4*FRf44M'1fe!!i%ie4f+llNetll9MMflltHlfi'11(IllltlR4frtYMRf�iylNkMMYMNM...y.Mkft 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 of Driver's license 03 -) V-"Zt) Z3 Signatu lic hief or designee 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. City Clerk or Office Use Only Approved application DCI report State certified driving record Website update J'�'-5-/S/ Date C1&kNAX1DRiv AWEAPPLe2018am W.DOC 04/2018 C410WADOTwww iowadot. v SMARTER I SIMPLER I CUSTOMER DRIVEN g0 D"vw & IEI"aftwon sarvlces PO Bar 9061 I Des Maines, IA 5=842D4 phone- 515-2"-91241 Fax 5 15-239-1037 N Certified Abstract of Driving Record o o� Inquiry Date: 11/27/2018 DL/ID #: 059BB9990(IA) Customer #: 541691-7 Name: Paul, Rodney Lee Class: C ID Status: None Address: 520 E 4TH ST APT 3 Audit #: 8939796 OL Status: -- VAL i Issue Date: 03/20/2015 CDL Status: None Za 1 r I City/State: WEST LIBERTY, IA Expiration Date: 03/18/2023 CDL Cert Status: None 527761455 - Endorsements: NONE CDL Med Status: None W Mailing Address: 520 E 4TH ST APT 3 Restrictions: NONE Restriction None CO Supplement: Date of Birth: 03/18/1963 Mailing WEST LIBERTY, IA Sex: M city/State: 527761455 History Information Convictions Citation Date Conviction Date ACD Ex lanatlon County7UR 08/08/2016 10/02,/2016 S92 Seed Grund IA 07/18/2017 09/05/2017 S92 Speed (10 mph & Johnson [A under in 35-55 mph zone Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number 3UR 105/16/2017 982609 IA Name: Paul, Rodney Lee DL/ID: 059BB9990 Pursuant to Iowa Code §321.10, 1, 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: Paul, Rodney Lee DL/ID: 059BB9990 11/27/2018 A{.42e QVCJ f/[ Driver B Identification Services Iowa Department of Transpombon • Nov. 30. 2018 9:31AM DCI IOWA 11/27/2018 1139 Yellow Cab STATE Ox.110WA Criminal MdarfHecdrd,Cht6k �r,.�n�s#`FaFrlbt Td . lbt4#�1k►�ion.4C(?tlnpinaliu�eatiprtion s`�ppo�i:oper$e14na�1�,reai�,1^'pluox 28 k o Street DOW •i�fNues,:iowa':5031 (S�Sj72$:61J80 Vic. IAmreauastin¢arila�usi'shtr�ireY�Ti�{nnv-tYecmxdl�f,rrtrn,.• . . No. 3016 P. 1 FAM19338 2700 P.0021003 DCi Account Number. _99617-F (iPapplio WO Brum: 36e11pw CAVd..IoVFAgA P.O. Bare 428 Iowa �"BY� IA 32247 (37'9) 338-x'7'7 Moak, -ra ., tai 3a9 -moi. �leSf,1)1Ah1V. . Rfk�Bi'.�ia1d'C.�nfa, ,. 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