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Home My WebLink About19-0631 l t CITY OF IOWA CITY 410 East Washington 51rccl Iowa City, Iowa 52 240-1 826 (319)3S6-5040 (319) 356-S497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO. 19 —" 0(0 (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 comp/ete the 'required" information will result in denial of the application 2. Address (REQUIRED) I �I PA { 3 Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQU b. Taxicab Business Name (RFQUIRED) 5. Prior experience in transportation of pas First Phone: (All written communication sent via email) 9 6 Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? t�n 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? �(/�Is What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspend Plead Guilty Other / 8 Has your driver's license or chauffeur's license been suspended or revoked in the as ve years? IS In Type of offense Where When 9. Hal elyou ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) (SECOND 0412018 1. 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}, certify 1hat I have issued to me by the Iowa D partment of Transportation a valid Driver's license number --7� r: lS�4% issued on _1expiring on/ 12 W2_2_ . I understand that if I falsely aft*ef any que ins in this application, that this application may be denied. I agree that in making this application, 1 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), .. K� i,_ � �4 Si1A S Date c (— ,- STATE OF IOWA ) COUNTY OF JOHNSON ) SW2scribed and sworn to before me by v r, n i� . ti (i s _ on this 3 }y day of .NNN.......f.N...1.tfN....lf1.iNMN1N1fffN..fNN..HN.IfNfNNN111.1.i1NNMN.NN .1N1NN1NN 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 lieense SignaturP,-&Police Chief or designee II-Zh ZZ 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 Approved application DCI report State certified driving record Website update Gen�rtgODRrvaSDGEnaa�e10t6ame�oc+: [XJC Office Use Only i-3)-19 Date 0412018 Jan. 24. 2019 3:3/YM UGI IUWA No. II r, q/9 Pram:tally m IOw2 11111' OIMm t 111041` 4110 9665407 01/10/0010 1,11:10 YY,a/002 . STATE OF IOWA Criminal history Recgd Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, 11t Floor 215 B. 7" Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6090 Fns I am renunctun¢ an Inwa Criminal History Record Check on: DCI Account Number: —1' (irapplimble) From: City of Iowa City City Clerk's Office 410 E. Washington Street Iowa City, 1A 52240 Phone: 319.356-5041 Faa: 319.356-5497 Last Name (mandatory) First Name (mama ) Middle Name (mmitzoent ed A�1g-G"1 'n - UaV1 arc Qe� Date of Birth alaldaIWA Gender mane Social Security Number recommea«a> No Iowa Criminal History Record found with DCI ale ❑Female ~ v Waiver Information: Without n 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 by law, always obtain a waiver st nature from the subject of the request. Waiver Released hereby givepamummn far me above requiting official to wnduclan Iowa criminal hislay record check wkb the Divisow orCrimilla hwestigation (DCI). Any criminal history data conrcming me that It maimainad by d,e DC(may be released as allov,W bylaw. 1 Waiver Signafure: Iowa Criminal History Record Check Results(v,eq,y) � As of ` � —,a search of the provided name and date of birth revealed: 'n ` rn 0 z m on No Iowa Criminal History Record found with DCI 3 z ~ v o � N a ® Iowa Criminal History Record attached, DCT /f D DCI initials_ N 1 N r�rl-77 (09/25/101 Received lime Jan. 16, 2019 3:06PM No -9924 ARTS Page 1 of 2 IOWA DOT SMARTER I SIMPLER (CUSTOMER DRIVEN www.lowadot.gov Drier i W fArstation Services PO Box 92041 Des Moises. IA 50306920/ Phone 515-244-91241 Fax 515-239.1837 Inquiry 1/15/2019 Date: CRY/State: Customer 4292418 0: 621 1/2 BROWN Name: Allison, Kevan Michael Address: 6211/2 BROWN 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 History Information Convictions CDL Permit Issue None Date: CDL Permit None Date: CRY/State: IOWA CITY, IA 52245 Endorsements: Chauffeur 3 Mailing 621 1/2 BROWN Restrictions: NONE Address: Restrictions: Restriction None Halling IOWA CITY, IA 52245 Supplement: CRY/State: CDL Status: None Data of 11/29/1961 Status: Birth: CDL Cert Status: None Sex: M History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation IUR1 11/14/2015 02/11/2016 S92 Speed IA -JohnsonJ 04/09/2018 04/24/2018 F04 Seat Belt Violation IA iihnson Name: Allison, Kevan Michael DL/ID: 769YY0847 (IA) 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 1 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: pt�r or rb est°•o: 1/15/2019 Azoe` s Driver & Identifikation Services t Doou Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 1/15/2019 ARTS Name: Allison, Kevan Michael DL/ID: 769YY0647 (IA) Page 2 of 2 http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 1/15/2019