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Home My WebLink About18-115� r AZIII�� CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 Q 19) 356-5040 Q 19) 356-5497 FAX Last 1. Name(REQUIRED) k 2. Address (REQUIRED) 1 IDENTIFICATION NO. l (Office Use 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 First Middle 3. Contact Information (REQUIRED) Email: Cell Phone: )12 - Lp'�L�_ (All ritte communication sent via email) 4a. Driver's License expiration date (REQUIRED) GZ/ I ! 1,7_(:) ZI b. Taxicab Business Name (REQUIRED) yah nw CINh 5. Prior experience in transportation of passengers: kn 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere' Type of offense Where When hao,tAk� 1�l (l71 )�L C� Io W 9 2611 (jnVr01- Iowa C !Q C- i 7,0 IT' cn What happened to the char e? (Circle 0' onvicte ismisse Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years� Tvpe of offense When �r)l> yZ W hat happened to the charge? (Circle one) onvicte Ismiss Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's 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) r�_ , I6 04/2018 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). 11 hereby cert' that I have issued to me by the Iowa D partment of Transportation a valid Driver's license number Z AC .2 i Zissued on c7%3U )S expiring on C_2%19/ LI I understand that if 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicantN-- - DateliLfl 4Nf4*i1,4*N1Nl1N#!!!1f#NN*flff*lflff##N1f#Nf*4NNf4#.»f*#N1NlNNNf44Nf4*#NN#N1NNf4N.N*#N1N1N44*#lN4NlN#lff....ff#Nf STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by o 11 , fiu on this day of lu aL Di rY�i. Notary Public iktind for the Statf of Iowa NuIMu 729428 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 li e �7 Signat ; f Police Chief or designee L" aZ_M_Zl _< — F71 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. r � , �- Signature of City Clerk designee Date 1*t#iflt##Nf#{eNlN*1N#i#f14N11N*iNN#ifN4*iN}*#!N##INNNlN*NNNlN**Nf4NflN#!N**N4*NNN#Nf*#N1f#!!f*#NNl1N*i!!f4#f!!N* Office Use Only Approved application DCI report State certified driving record Website update aeM/TAXIDRMW)GEAPPL92018e ded.DOC 04/2018 n rage 1 or 2010WADUT'�. SMARTER 1I SIMPLER i CUSTOMER DRIVEN PO Blstt94A4 Q DW Bl IA 5=64W FWW SIM41 A1211 FU 51*09.1WT Inquiry 12/4/2018 Date: Customer 5225847 Name: Augard, Kody Michael Address: 2 DATA DR City/State: IOWA CITY, IA 522403009 Mailing 2 DATA DR Address: Mailing City/State: Date of Birth: Sex: IOWA CITY, IA 522403009 2/19/1992 M Certified Abstract of Driving Record DL/ID #: 128AC3932 (IA) CDL Permit Class: None Class: C Audit #: 9299091 Issue Date: 07/31/2015 Expiration 02/19/2021 Date: Endorsements; Motorcycle CDL Permit Issue None Date: CDL Permit None Expiration Date: Restrictions: NONE DL Status: CDL Permit None Restriction None Endorsements: None Supplement: CDL Permit ELG CDL Permit None Status: Restrictions: yr --� ID Status: EXP t. History Information CLEAR DRIVING RECORD Name: Augard, Kody Michael DL/ID: 128AC3932 (IA) get 1 rn ty�-�g C) 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: Name: Augard, Kody Michael DL/ID: 12BAC3932 (IA) 12/4/2018 d9-- Driver & Identification Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 12/4/2018 i7 Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: yr t. CDL Cert Status: None Cfi CDL Med Status: None J History Information CLEAR DRIVING RECORD Name: Augard, Kody Michael DL/ID: 128AC3932 (IA) get 1 rn ty�-�g C) 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: Name: Augard, Kody Michael DL/ID: 12BAC3932 (IA) 12/4/2018 d9-- Driver & Identification Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 12/4/2018 AK1J Page L or L N c� GJ d J http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 12/4/2018 Dec. 10. 2018 4:18PM DCI IOWA No. 4442 P. 1 Frum:Olty of Iowa City Clerk Otflee 319 3666497 12/04/2016 16:46 sY 7 V.UU2/002 S'T'ATE OF IOWA i"--, , a Tl• .. .-., - tiaauiiiiu.i iaiSiii►y Request Form DCI Account Numbcr: (if applicabk) TO: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 L 7't' Street Des Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Fax I am reauestinL, an Inwa. (ltiminnl )iietnry Rr nntA Chorlr nn• From; Cts of Iowa City City Clerk's Office 410 E. Washington Street Iowa City, IA 52240 Phone: 319-356-5041 Fax: 319.356-5497 Last Name (mandato) First Name (mandatory) Middle Name (recommended) Liuya J� �� A IoAe� Date of Birth (Inendato y) Gender (mandatory) Social Security Number (recommended) QZ ly Male ❑Female ZI -39�z Waiver Information: Without a sighed waiver from the subject of the request, a complete criminal history record may not' be releasable, per Code of Iowa, Chapter 692.2. For com tete criminal history record information, as allowed by lavi; always obtain a waiver signature from the sub ect of the request Waiver Release: i bereby give pennisi(on forthe above requesting official to conduct at lows criminal historyrecord Check with icDivision of Criminal Investigation (DCO. Any criminal history dela eoneaning me that is maintained by the DC1 may be released as allowed by law. Waiver Signalare: Iowa Criminal History Record Check Results (DCI use only) As of 111 �a /�t (FSa search of the provided na(De and date of birth revealed: "." ® No Iowa Ujlnitial History Record found with DCI ( ,1 Iowa Clituinal History Record attached, DCI # J r' DClinitials 01�s?� u t)C1-77 (01/25110) n --- :_.-s T:... n.. A IA10 A,A1Ptt tln 7(,01 Dec. 10, 2018 4:18PM DCI IOWA No. 4442 P. 2 ' IOWA CRIMINAL HISTORY DCI 00934732 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2018/12/10 DCI:00934732 NAME: AUGARD,KODY MICHAEL DOB SEX RAC HGT WGT EYE HAIR SKN POB 19920219 M W 503 100 HAZ BRO IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT R BAST CCH RECORD 01 ARRESTED/TAKEN INTO CUSTODY 20110708 AGENCY: IA0180000 CHEROKEE CO SO CHARGE NO- 01 IA STATUTE IA709.4(2)(C)(4) SEXUAL ABUSE 3RD DEGREE -DEFT UNDER 20 TRK#: 081227601 COURT DISPOSITION AGENCY: IA018015J CHEROKEE CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2C(3) ASSAULT CAUSING INJURY, VIOL OF INDIV RIGIHTS COURT CASE ID: 03181 F9CR024205 CHARGE CLASS: MISDEMEANOR CONVICTION TRW 087327601 SENTENCE DISP SPF AAT FINE $625 20111003 An arrest without disposition is not an indication of guilt. This record by the Iowa Division Of Criminal Investigation, Bureau Of maintained Identification is a public record but can only be released to non -law m enforcement agencies by the DCI. ,NY= rm This response can only include public criminal history data. Under Iowa law,-. �. most juvenile records are confidential. Confidential juvenile court records,' �r� '"- 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 juvenile records, if any, an application must be filed pursuant to Iowa Code section -n 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www. iowaeexoffender.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 filed pursuant to Iowa Code section 232.147(18). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION �. Dec. 10. 2018 4:19PM DCI IOWA No. 4442 P. 3 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 juvenile 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: h1tp,11www.lowasexoffender.com1, 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 filed pursuant to Iowa Code section 232.147(18). R _a C—a