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Home My WebLink About19-058I . � P t Mlrtmi�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. (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 "required" information will result in denial of the application Lt� Middle /LL,1.V—r 3. Contact Information (REQUIRED) Email: Y£tt JW�A4,ZC. e3� Cell Phone: Y127 _ YI ' (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) f 35 zz' �Q b. Taxicab Business Name (REQUIRED) YGt, ou CA8 0).J0 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 N CD What happened to the charge? (Circle one) �m 3� E3 Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? --A/� �. 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 taxi driver using a different name? If yes, please provide the name(s) ,0 04/2018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 that I have issued to me by the Iowa Dep rtment of Transportati n v Driver's license number ✓j IO/�b issued on expiring on 1 understand thatrf I falsely answer any questions in this application, that this ap kation may be denied. I Jgree 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 ap n, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provis' s orTitle pter 2, of the City Code. (Needs to ;7;1; front of a Notary Public) Signature of Applicant Date .o 7M. n_, G-) _ _ J r STATE OF IOWA COUNTY OF JOHNSON )) Subscribed and sworn to before me by on this w 1 day of ASHLEY A JAY-PLATZ I A � W ' E85030 y= Notary Public ip a the State e July 14, 2020 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 Driver's license /.-, ( I Signatur g olic Chief or designeeI 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 QeWT XIDRNBADGEAPPL9201 M"nC .DOC '341'1 Date 04/2018 071Aug. 5 2019 4: 1510b DCI IOWA fdv0319338INo„ 3230 r - STATE OF IOWA Ciminal History Record Check Request Form To: Iowa Dlvlsfon of CrimloaI lnvestigatlon Support Operations Bltreau,11 Itloor 215 L 7m Street Des )Moines, Iowa 50319 (515) 725.60,66 (525) 723 -6080 -Pax I am requesting an Iowa Criminal ilfstory .Reenrei f`henle m,• P. r �JO2/002 DCI Account Number: _9967'' (if oppllaabla) Froml Yellow Cab ofYoew City J?.0. Box 428 ' Iowa City, IA. 4*4 (319) 338-9777 Phone: w Fas;: (319) 339-7302 Last Name (mend First Name ;..d dle Name (reaommendad) toll o As of a search' of the provided natti�nt�nand t(iate tTf bed: .. Lu Data of Birth (matwomm Gender (mandatory)`SoccW,Secnri Number ( ammuendad) 7 31 /% �' �lVlale ❑Fetnalo 781790—t�s27s l r� .a. Waivel' 1'nfonnation: Witbout s signed iyafver from the subject of the request, a complgtn griminal history record play nor be releasable, per Code of Iowa, Chapter 691.7,. For complete criminal history record information, at allowed by law, ahvays obtain a waiver al nature from the 30j eerof the request. Waiver Release; I hereby give permission for dtti'abo requestlnt< official to aondua an low% arimidai �tbtay rmwd chock with the Division of Criminal Invariaidon (DCO. My Criminal hfsmy data con at is ad by the DCT may be released upglowdt by law. Waiver Signature; .LV/Iia 1...11atlAAAill 111, tV ry x4Cl:V ru %yAACVK x6at prq,�iq (DCI no am��yy}}} toll o As of a search' of the provided natti�nt�nand t(iate tTf bed: .. Lu g LplJ No Iowa Criminal Histo y Record found witkl,DC�C•+', � _ yC 0 es l r� Q ❑ Iowa Criminal History Record attached, DCI ir` e° O ....• > o DCI initials DCI -77 (08/25/10) Received Time Jul, 30. 2019 12:57PM No. 2238 µ`Aug. 5. 20 19 4:15PM DC] IOWA No, 3230 P. 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 confidentlal juvenlie 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.1Avww.lowasexoffender.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). N O O 4D Ry ab C i m a s w J10WA00T www iowa ot. v SMARTER I SIMPLER I CUSTOMER DRIVEN d gn DrNer & Identification Ssrvioas PO Box 42041 Des Moines, IA 50306-9201 Phone 515-244-91241 Fax 515.239-1837 Certified Abstract of Driving Record Inquiry Date: 8/6/2019 DL/ID #: 435ZZ1025(IA) Customer #: 2308987 Name: Bradley, Roger Elliot Class: D ID Status: None Address: 2327 E COURT ST Audit #: 3047038 DL Status: VAL 522455218 D Issue Date: 07/31/2018 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 07/31/2026 CDL Cert Status: None 522455218 History Information CLEAR DRIVING RECORD Name: Bradley, Roger Elliot DL/ID: 435ZZ1025 CDL Med Status: None Restriction None. Supplement: N o_ Endorsements: Chauffeur 3 Mailing Address: 2327 E COURT ST Restrictions: NONE C-)—< Date of Birth: 07/31/1965 Mailing IOWA CITY, IA Sex: M City/State: 522455218 D Cl) Cl) History Information CLEAR DRIVING RECORD Name: Bradley, Roger Elliot DL/ID: 435ZZ1025 CDL Med 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: Bradley, Roger Elliot DL/ID: 435ZZ1025 8/6/2019 Driver & Identification Services Iowa Department of Transporation N o_ �n C r 1 C-)—< J 1 G rn y. M 3z D Cl) Cl) 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: Bradley, Roger Elliot DL/ID: 435ZZ1025 8/6/2019 Driver & Identification Services Iowa Department of Transporation