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HomeMy WebLinkAbout19-011CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. q (Office use'oy) 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 aonlication 3. Contact Information (REQUIRED) Email:a,-,eon Cell Phone: All written communication sen via emai 4a. Driver's License expiration date (REQI b. Taxicab Business Name (REQUIRED) 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? Type of offense Where When �P rn4tiL(A Cl i M nJ ro 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? �4 n Type of offense Where When l What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other (8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? :$05 Type of offense Where When sR z z 9• 6 ,29- 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) NN (�) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARv1 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 k -r y� '�thatlI have issued to me by the Iowa De rtment of Transportation a valid Drivers license number IIMf issued on 07- 1 expiring on l2' j 7_ �, I understand that if falsely answer an quest ns in this application, that this app cation 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 nl of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant_ Date 3 -' j v STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and swom to before me by (Vcttitl on this _day of -;7 wV cx� 2-00. c1. r� I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determir ed 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' i e� Signatur€W Police Chief 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. Office Use Only Approved application DCI report State certified driving record Website update l -a>3 - lei Date OwkrrAXIDR MMDGEA W'L9201 aam&XW. DOC 04/2018 C4010WADOT www iowadoG ov SMARTER I SIMPLER 1 CUSTOMER DRIVEN g DrNer B ldsnttdttinon sorwilm PO Box 92041 Des Moores. IA 50©06411201 Phcrle 5 15-24 4-9124 1 FM 515-23}11197 Certified Abstract of Driving Record Inquiry Date: 1/10/2019 DL/ID #: 569AG8111(IA) Customer #: 5833104 Name: Akakpo, Mana Class: C ID Status: EXP IA Stephanie Requirements ^� Address: 1100 ARTHUR ST Audit #: 2877482 DL Status: VAL APT G4 Suspended, Denied, Suspended 06/09/2014 06/08/2015 B63 Issue Date: 06/07/2018 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 08/17/2025 CDL Cert Status: None 522406611 Endorsements: NONE CDL Med Status: None Mailing Address: 1100 ARTHUR ST Restrictions: NONE Restriction None APT G4 Supplement: Date of Birth: 08/17/1993 Mailing IOWA CITY, IA Sex: F City/State: 522406611 History Information Convictions Citation Date Accidents Conviction Date ACD Explanation County 7UR 09/23/2013 09/25/2013 861 Violation of Accident Wapello IA IA IA Requirements ^� 08/31/2015 09/22/2015 B20 Driving While Des Moines IA 71 License Suspended, Denied, Suspended 06/09/2014 06/08/2015 B63 Fail to Refile evoked Cancelled Revoked- IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. J Accident Date Case Number 3UR _ _ 08/21/2015 _ 874505 IA Sanctions Type Effective End ACD Explanation Occurrence JUR ]UR Suspended 10/31/2013 11/29/2013 D29 Violation of IA IA Restricted License Suspended 06/09/2014 06/08/2015 B63 Fail to Refile IA IA SR22 Suspended 08/27/2015 10/30/2015 B63 Fail to Refile IA IA SR22 Suspended 01/13/2016 07/13/2017 D53 Non -Payment of IA IA Iowa Fine Name: Akakpo, Mane Stephanie DL/ID: 569AG8111 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: Akakpo, Mana Stephanie DL/ID: 569AG8111 1/10/2019 Driver & Identification Services Iowa Department of Transporation Amzi� 01/Jan. 15. 2019;., 4: 30PM Cab DCI IOWA IF"I STATIR OF IOWA Criu6aEqm:r,yRmrd Check To. Ieara MvWen ofCx1minaLlivestigation. SOPOAOpevai I d , 40 "a"' il * M24,13'Floar M BOO Wept Dal *t llhi>� WWII 00319 00319MNo- 9706 P. 1/2:1002 DCI Awount Nmnbcr: —9967-F— (if w0l-we) RD= Ye60N* Cab P.O: Box 429 lowiw 4MIY, U. 52244 04-11) 338-9777 Phone. Fat. (319) 339-7361 Lust Nsmae (DC1 uu only) tio doe mn- < n Date.. E3 -No Iowa cmung instory Record fburid with DCI 0 542 --0 1 9 12&- -n -W�Idverfrbm-A-0.044t, qf,fke4,101 W*ot bereleambir, Code-otlows;ChaptertgIz. FeffLovip historyiicuNiufo i>YtTaw, per. vrfaria4l udo%us m0owed Idw"y CIO ftftr ftlew. Lb qAfVTqp .0"Imu" 01w *md hika�bmLghthlewfth-the Divitihn of Criu(iml Inv4dodo ;0 . � ,6v %mitial jhM Ir ;a)ntsUa4,6y the L. . . . . . . ilx.mmmq�uxu 1LQ3mACN (DC1 uu only) As of � 715 01ho PreyideO naMo PAO date of Wrth rvv1z*eA' < n E3 -No Iowa cmung instory Record fburid with DCI 0 -n lowa, Crtmiad RTstory Record atrachpd DCL# CIO DO ini6is DCI -77 Received Time Jan, 10. 2019 4:44PM No, 9052