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Home My WebLink About19-040CITY IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. /q-t>L4b FILED (Office Use Only) APR 3 0 1019 APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER (Police DepartmenC446*11 iiertitltst be made between 8 a.m. to 3 p.m., Monday — Friday) Iowa City, Iowa Failure to complete the "required" information will result in denial of the application First Middle 3. Contact Information (REQUIRED) Email: Cell Phone: 7 ='7 3 3 I " So Z (AII written communication sent via email) 4a. Driver's License expiration date (REQUIRED) Z c b. Taxicab Business Name (REQUIRED)l P n ,,.r C40 [ v w,q C y 5. Prior experience in transportation of passengers: T>,r t u e q 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Ifs Type of offense Where When 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? blIDI Type of offense Where When 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? Type of offense Where When 9. Have you ever applied to be an Iowa City driver using a different name? If yes, please provide the name(s) J Kt:UUIKtU 04/2018 l 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 hereby certify ttfat have issued to me by the Iowa Departent of Transportatio a valid Driver's license number L / issued on / "> expiring on / 7 � . I understand that if I falsely answer any questions in this application, that this app cation may be denied. I re 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 provi on of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date D / _ APR 3 0 fnm STATE OF IOWA ) COUNTY OF JOHNSON ) ^� Iow/ylewaci oa and sworn to before me by �ZL&IA r 5 f 11 u on this day of 1 .n lh s. MA) Nunl1w the Stal#of Iowa #f###,tR#fIi#ffff###f#I(#ffleftfMF}##f#Rflfff##Y####}1,#fff#ff########ffffffff##t1#fflrfffffff###I�#1(fifffff###M,#fff 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 river's license T7 Sign Po" or designee i5 ate 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. Of Approved application DCI report State certified driving record Website update OeMffAXIDRN6IDGEAPK9201 &amended.DOC Office Use Only Date ' 04/2018 �46'OWA DOT wwwi wad v SMARTER 1 SIMPLER I CUSTOMER DRIVEN 0 OL g0 Diner & wnWBeatlon sl 1041s PO Box 92M I Des Moines. IA 543069241 Phone 515-244-91241 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 4/24/2019 DL/ID #: 445AF9612(IA) Customer #: 5722274 Name: Dumont, Dennis Class: D ID Status: None Charles Address: 2491 HOLIDAY RD Audit #: 1707445 DL Status: VAL Issue Date: 03/28/2017 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 11/11/2020 CDL Cert Status: None 522414705 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 2491 HOLIDAY RD Restrictions: Corrective Lenses, Restriction None Left and RightSupplement: Outside Mirrors, Left Outside Mirror Date of Birth: 11/11/1945 Mailing CORALVILLE, IA Sex: M City/State: 522414705 /`rte History Information • I L ELW APR 0 1619 CLEAR DRIVING RECORD City Clerk Name: Dumont, Dennis Charles DL/ID: 445AF9612 Iowa City, IOWA 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: Dumont, Dennis Charles DL/ID: 445AF9612 4/24/2019 C Driver & Identification Services Iowa Department of Transporation APr.29.2019 10:19AM DCI IOWA 0412312019 13:13 Yellow Cab No. 8546 O'A103193382708 P. 2 P.0021002 STATE OF IOWA LJ c0iniwaI History Record Chi 0 tni9 ' Request Form to Cary Clerk city, Iowa t. To: Iowa Division of Criminj Investigation Support Oporations Bureau, In#10or 215 E. 7" Street bes Moines, Iowa 50319 (515) 725-6066 (515) 725-6080 Fax I aitl roquostlne an lows nriminnl DCI Acoouht Number: 9967-F _ ��(Ifepplleabl0) From: Yellow Cab of Iowa City _ P.O. Box 428 Iowa City, U. 52244 (319).338-9777 Phone: Far. )339-7302 Last Name`Ifirst Name (mandamW Middle Name (r000mmaeds ual f r�.Ir-1 Date of Birth mandac ''Gender mandatory) bSOcial-SecurityNumber recomme tical 11 /1 '!SQ) �iVlale ❑Female D2_"A -L S`"7 WPaivsrinformationrWithout a signed waiver from the subject of the request, a cotnpiete 4rimlaal history record Ipay not be releasable, per Code oilowa, Chapter 692.2. For eomntete criminal history record informat5on, as allowed by law, Always obtain a waivers nature ttnm the sub ecr'f the uesk 17ratYer Re1.eaSe: i harcby slut permission for rhe ' rn rcqucsung ot6eial to conduct an Iowa criminal history imord uhoelr with the Divblon of cdmtrml lnw"tliet(On (DCI). AMY criminal hlrpty dam oanoanin m that i5 maintained by th CI maybe fdeased WkW54 bylaw, Waiver Signature: As of _ 4-,1 R a search of the provided name and date of birth revealed: ----No Iowa Criminal Hist T u'Record found wish DCI J ❑ Iowa Crlminat His#ory I{acord attached,DCI A ` 1 DCT itiidals._,� DCI -77 (08/25!10) ROrpivol Timp Anr 11 9o1Q 1•AAPld Nn 7761 (DCI use only) a O f? -n N "' i ti c� z' w cn y Apr, 29. 2019 10:19AM DCI IOWA No. 8546 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 confidentlal 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 confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). APR 3 0 2019 City Clerk Iowa City, Iowa