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Home My WebLink About19-025t � r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED', IDENTIFICATION NO. /C( —DJ (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department�rO�yiew must be made between 8 a.m. to 3 p.m., Monday— Friday) MAR 2 9 Failure to complete the "required" information will result in denial of the application Iowa City, io'wa First Middle 3. Contact Information (REQUIRED) Email: 04 (-V 1 ECI^4- (OC" Cell Phone: 319 S9`/ 798Z (AII written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 0 (/ z y/ 26 b. Taxicab Business Name (REQUIRED) `/C (to CV IQ b c 5. Prior experience in transportation of passengers: -r r"f5 t,4,`-lkL 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where O7/b �/7016 Convicted_. dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When What happened to the charge? (Circle one) onvict Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? IV 0 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) F'AUt: FUR 04/2018 J 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 RE)q,w111h[JIJ You must apply for an individual Department of Criminal Investigation Report (form available upon request). I hereb erpt �¢a) 1 h jssued to me by the Iowa Department of Transportati n valid Driver's license number PP y 1 }S issued on 03 `6 Z0Isexpiring on Or/ Z 7003 . I understand that if I falsely answer any questions in this application, that this applIcation may be denied. 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 TW, , Chapter , of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant STATE OF IOWA ) COUNTY OF JOHNSON ) and swgrn to before me by S ',_ ,' 4, 1-0) S (zt-b c.iton this 9_p day of �,1 and for 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). license oL/ - Z `i - Zt) 2 3 J7 or designee 07 26-/ 9 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. Sign ture of City Cie or designee Date Approved application DCI report State certified driving record Website update CAaW"I)RNa4DGEAPPl92018anvncM8d.Opp Office Use Only 04/2018 C#10wa00T SMARTER I SIMPLER I (UST QMER DRIVEN vuWw.IOWadogbv� <- ,, ,y Drw a IOItMMkaUon seniaf PO Box 92M 1 Des Moines. IA 503110i- e phone: 515244-91241 Fax 5152391857 Certified Abstract of Driving Record Inquiry Date: 2/26/2019 DL/ID #: 769YY1758(IA) Customer #: 1272105 Name: Lottich, Christopher Class: D ID Status: EXP JUR John Suspended 03/04/2009 12/21/2009 D38 Address: 1463 WESTVIEW DR Audit #: 8934357 DL Status: VAL Security for an Issue Date: 03/18/2015 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 04/24/2023 CDL Cert Status: None 522411031 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1463 WESTVIEW DR Restrictions: NONE Restriction None Supplement: Date of Birth: 04/24/1979 Mailing CORALVILLE, IA Sex: M City/State: 522411031 History Information Convictions Citation Date Conviction Date ACD Ex lanatlon County JUR 06/19/2016 07/07/2016 M14 Fail to Obey Traffic Si n Si nal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date _ Case Number JUR 112/2212008 1480109 IIA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 03/04/2009 12/21/2009 D38 Fail to Post IA IA Security for an Accident Name: Lottich, Christopher John DL/ID: 769YY1758 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: Lottich, Christopher John DL/ID: 769YY1758 2/26/2019 Driver & Identification Services Iowa Department of Transporation p,ML.L-j. 20191:_5 :.29.tN Cab DCI IOWA qAMIS No_ 1172 P. 1/2,1002 I STATE OF IOWA I Criminal History Record Check • ° Request Form i To: Iowa Division of Criminal Investigation Support Operations $urean, 1" Floor 215 I3.7" Street Dw Wines, Iowa 50319 (515)725-6066 (515) 725-6080 Fax i . I am ro"astina an Iowa Crimliral•iiistorvLoord Chank nn, DCI Account From: 9967-F (if appuwtde) LA. 52244 (31.9) 338}9777 Phone:. • I I+ax. (319)33917302 i Last Name,(manaatory) k•Wt Name lVXid Name a�e„dw) L a ri �M `andato C�f15j d Ir.ef•, I t Date of Birth (mmdatory) Gender (mandatory) 'Soelallecurt Numb rmnimendod tglMale ❑Female Ll 3 • Wi2iver Information: Without a signed %elver from the subject of the regpest, a complats Mmi sal history record may not be releasable per Code of Iowa, Chapter 692.2, For com Ie criminal hlstotyracor� talo on, as allowed by law, always obtain a waiver signature from the sub ett,pf the r uest W WaiYHr IieiCQSE; t htreby ttvo pctmtttlon !br ft ihova request' - toiU to mndua m Iowa odm I I • Iswry tccord chcde with the Division of CnYnlnal Invsetig�don (DCT). My cAminal history data oonoarnlhj mo that ned by the D ey allowed by (aw. I ti Valvar Sign4ture; i As of 311 J i n search of Tho provided name and date of birth reveale No Iowa Criminal History Record found with DCI j u ❑ Iowa Criminal Wlitory I�eeord attached, DCI # DCI i'ilitials f I I.. DCI -77 (08125/10) t. Received Time Feb.25. 2019 7:27AM No,6483 (DCl us only) v C � W m tO -n z en rg Z `� Mar. 1. 2019 5:29PM DCI IOWA No. 7772 P. 2/2 DISCLAIMER This response can only Include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidentlal 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: httn //www.lowasexoffender.com/. However, even though some information is available on this site, the actual records forjuvenlies 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 tiled pursuant to Iowa Code section 232.147(18).