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Home My WebLink About19-012CITY F IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-SO40 (319) 356-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO. I — (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 "reguired" information will result in denial of the application 2. Address (REQUIRED) 7 � I Mi 3. Contact Information (REQUIRED) Email: First (AO (12722- written communication sent via email) 4a. Driver's License expiration date (REQUIRED)) I 1 2 7 22 b. Taxicab Business Name (REQUIRED) A i q It) q7ly7 5. Prior experience in transportation of passengers: Phone: 5 ! y — 6. Have you ever been arrested / charged With any misdemeanors and/or felonies in this State or elsewhere? Type of offense W here When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Gui ly Other' 7. Have you been arrested / charged With any traffic offenses in the last five years? wnat nappened to the charge? (Circle one) Convicted Dismissed Deferred Suspende PlKI) Guilty Other ,, / 8. Has your driver's license or chauffeur's license been suspended or revoked in the as ve years? I) Type of offense Where When 9. Have ryou ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 0412018 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 hereb cert' hat I have issued to me by the Iowa D partment of Transportation a valid Driver's license number �47 issued on o 3 ty_expiring on / 12 q2. 2-. 1 understand that if I faldely'a a any quedti6ris 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 Applicant �)vQ VA u or" Date Q I STATE OF IOWA ) COUNTY OF JOHNSON ) Sytgribed and sworn to before me by v `n . ( s on this 3 o{h day of the State Mewa -713 ll41RtN#ktRf!#WkRfltklr�!!fH/RRfH/11R1"MMt�fMMefMMNH/M�f MMII(4MMIefeM#fIR4MiHR4f Mk1fi1H 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). o Expiration date of Driver's i nse 1 I -7- `! Z Z i y � °I -7I-11 Signatur olice 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. or ignee Date Office Use Only Approved application DCI report State certified driving record Website update Oe AXJD iN94DGEAPPl92018e�.DDC 04/2018 Jan. 14.1U19 J:JIFM UG1 IUWR No. IItd06 r. 4/7 FrOM:eirly Or IOw& Clay clerk Vrr1Oe 319 3666087 01/16/mole 1s:10 r..../002 STATE OF IOWA Criminal History Record Check (9 Request Form To; Iowa Division of Criminal Investigation Support Operations Bureau, V Floor 215 F. 7"' Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6080 Fax I am reauestinsr an Iowa Criminal History Record Check on: DCI Account Number: 4C-ya- —1' Of applicable) From: City 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 (mandatory) First Name (mandatory) Middle Name (rcwnnocaded) A(,cl— ZaV, r4`c a,�J ` Date of Birth (mandatory) Gender (mandatory) Social Security Number rreeemmeaded) z m o No Iowa Criminal History Record found with DCI z z MUale ❑Female 'i( Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed bylaw, always obtain a waiver signature from 1be subject of the request. Waiver Release; i hereby givepermisslon for the above rciluesiiag onldd to conduct an Iowa criminal history record check with Ins Divisia.40iminai hwastigadon(DCI). Any aiminat hisiory data conmming me that is mawidned by die DCC may be released as allowed by low. Waiver Signature-, 1 Vx� Iowa riminal History Record Check Results,n;;q,,y) As of L a search of the provided name and date of birth revealed; ` D z m o No Iowa Criminal History Record found with DCI z z .r F5 N ® Iowa Criminal History Record attached, DCI# v° DCI initials,,_ N 1 y QQT-77 (OMS/10) Received Time Jan. 16. 2019 3:06PM No, 9924 ARTS C210WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov Inquiry Date: Customer 1/15/2019 4292418 Name: Allison, Kevan Michael Address: 621 1/2 BROWN City/State: IOWA CITY, IA 52245 Mailing 621 1/2 BROWN Address: Chauffeur 3 Mailing IOWA CITY, IA 52245 City/State: None Date of 11/29/1961 Birth: None Sex: M Convictions Page 1 of 2 Dnv*r & IdontifiCation $VViws PO Boz 9204 1 Des Moines. IA 503069204 Phone 516244-9124 I Fax 515-239.1837 Certified Abstract of Driving Record DL/ID #: 769YY0847 (IA) CDL Permit Class: None Class: D Audit #: 9136520 Issue Date: 06/03/2015 Expiration 11/29/2022 Date: Explanation Endorsements: Chauffeur 3 Restrictions: NONE Restriction None Supplement: -Johnson �. History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation CDL Permit None Endorsements: 02/11/2016 CDL Permit None Restrictions: -Johnson �. ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None N O 1 :itation Date Conviction Date ACD Explanation JUR County _ L1/14/2015 02/11/2016 S92 Speed ]A -Johnson �. )4/09/2018 04/24/2018 F04 Seat Belt Violation IA Jphnson Name: Allison, Kevan Michael DL/ID: 769YY0847 (]A) 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: http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 1/15/2019 A1/15/2019��^""" ��20�r��. L Ablzl— Driver & Identification Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 1/15/2019 RAI VI Name: Allison, Kevan Michael DL/ID: 769YY0847 (IA) Page 2 of 2 http://172.29.254.55/drivers/reports/customerhistorylcertifreddrivingrecord.aspx 1/15/2019