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Home My WebLink About19-004* IDENTIFICATION NO. 1q— l 1 (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-SO40 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) 46 Failure to complete the "required" information will result in denial of the aonlicadon 2. Address (REQUIRED) IIIA 3. Contact Information (REQUIRED) Email: 4a. Drivers License expiration date (REQI b. Taxicab Business Name (REQUIRED) First Phone: (All written communicati6h sent via email) 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? Ur) Tvce of offense Where W heti - 1 cn 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?-✓ Jl'C 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? .4 A Type of offense Where When 9. Have u ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) FOR 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). I h r bX cert hat I have issued to me by the Iowa Department of Transportation v I' Driver's license number issued on �xpiring on CM7 =I understand that f I falsely answer any questions in this application, that this app ceti n 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 provi ions of Tide 5 Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican Date QL Q - 0-1 - N 0 o _ 7 STATE OF IOWA COUNTY OF JOHNSON Subscribed and swor9 to before me by 4� ()Pl Ht)t feyon this_ f1Gt I` �! as !LI day of 1A r^Moicnuc ry uev i / /// %li/%/, v Public in 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 've ie�nse 0y -'?I-7.3 �7 cr-c7-/q Signat of Police Chief or designee Date i 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 Office Use Only Approved application DCI report State certified driving record Website update C*krrAXIDRNH4DGEAWL92018WTW,de .DOC I-7-/% Date 04!2018 72toieiui611Y1.gi r'w"QWCab DCI IOWA SATE 0-p'.3tCM—A Crhn!Ul*Mtor,y Record,C71tak . �egp(esti Eox'nii T,Ct IOWA DlVutmoftdmlmdlo'vgsigatitin SUoportogogilous lw."A,1.4 Flaw 210&1* Street Des lQUes&,Iowa 10419 fs3�1.9z�bTlau.r'.i (FAX)319338uuo r.uu21002 DClAo=mtNumlw: ;9.9'67-F (04 11.0 From: 'Y'elkW Cab of lova City P.O.'B'ox 428 YowA �1ty; int. 5 ' (3D).3 -i8-9777 Phone: lr4xr 339=7503 sst. euro mus ,. :.. Firs1E l`T$me(dimid�mpy.•.... �. .:11[ddle',(arsnie (rcen�rynended}. r` c ;-, No ZOWR iy£mitla Mstorg'Record found with DCT N=ber necwn,M a) _ Female l.� �I v�✓ a3vr:1 k ilyO Gt,Y'iYi.t..f dp�•lid'!te'Clef!igysklliiztory recmdlnaywos be releasable,per Code, otTow4iCb40tef•442iFat wMl)lg�ertminaiAistory�fapriJ'igt�hmwtloly�s.allowed byla+i,ah" 'aiura[rofiitb' obtafir.aivsars:si >n eetdt'�ttor t, ' W4lyft X161 8.1'fioldl p'p�bntujaFl6ruapbQve lnresdtadon (DCf), kn7:a Ct, hGo rggeegltngod{pjdtocodduc[aFlo�iyslm30Slliist➢°Y'ree?C�t�rxk wrtH the DivisinnofCim" War is meintdned..690a heiYleesnA`tr.IfcvsFa itrjlgi.'., ACt>zfruals�� >C l vttio R4dc&d Check Results ; : (DC1 nk onty). - As of t a A seairl� of the pr0�ided.aaze acid daFe wf Raittil aevesied; r` c ;-, No ZOWR iy£mitla Mstorg'Record found with DCT .13 :Iasva Criminal'fSfoigrCecord atiactiea DCt#. _ '� ACt>zfruals�� rn N Received Time Dec.31. 2018 11:36AM No.7317 . Jan. 2. 2019 1 : 12PM ON IOWA No. 7522 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 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: http://www.iowasexoffender.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 confidentla!juverlle records, If any, an applicatior, rust be filed pursuant to Iowa Code section 232.147(18). V UVr 'IV 17 I IAL rCIIVw LdU tWg319 338 2708 P.0011001 (4010WADOT S1, UTER 1 SIAIPLEFi f CUSTOMER DRIVEN lrtirum.io1;M1i8tiC gav DChvK a teellaitallM &BYIIOq PQ Ba:t SIt6'd i Oesfdoinis.lA SOaDE�pM Phone: 5115-M"I311 Fax: $I r2WISr, Certified Abstract of Driving Record Inquiry Date: 12/31/2018 DL/ID #t 333AP1683 (IA) 'Customer #: 6831862 Name: Humphrey, Valerie Class: C ID Status: VAL Chanel Address: 1500 Arthur St Apt Audit #: 3436553 DL Status: VqL History Information CLEAR DRIVING RECORD Name: Humphrey, Valerie Chanel DL/ID: 333AP1683 CDL Status: None CDL Cert Status: None CDL Ned Status; None Restriction None supplement: 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.- Humphrey, Valerie Chanel DL/ID: 333AP1583 12/31/2018 1 Driver It Identification Services Iowa Department of Transporstion Issue Date: 12/04/2018 City/State: lows Cityy IA $22406613 Expiration Date: 04/21/2023 Endorsements: NONE Mailing Address: [500 Arthur St Apt Restrictions: NONE Date of Birth: 04/21/1993 Mailing Iowa.City IA Sex: F' City/State: 522406613 History Information CLEAR DRIVING RECORD Name: Humphrey, Valerie Chanel DL/ID: 333AP1683 CDL Status: None CDL Cert Status: None CDL Ned Status; None Restriction None supplement: 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.- Humphrey, Valerie Chanel DL/ID: 333AP1583 12/31/2018 1 Driver It Identification Services Iowa Department of Transporstion