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Home My WebLink About19-066CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB I 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 (319) 356-5040 Last First Middle (319)356-5497 FAX 1. Name (REQUIRED) r Ile 2. Address (REQUIRED) 2ND Ji � 3. Contact Information (REQUIRED) Email: Cell Phone: 3/9 Gz/ 70,t� (All itt�unication sent via email) 4a. Drivers License expiration date (REQU b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: / ea 0- 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? IVO Type of offense W here 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? &I Type of offenseI W here When r4/ -lc hap{ V -give%< 01 al�er 6dn46/ _ 7Ie6 b5F 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 t e years? /Vo 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) PAGE NOTARY) 04/2018 a 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 ce¢ify thpt I have issued to me by the Iowa D�p rim nl of Transportatio a valid Driver's license number issued on Z / expiring on /2 /1 ZQ25 I understand that N falsely answer any questions in this application, that this appy ti n 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, Cha to f t City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicantL Date % 6 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by k.-° --� ul-e- tau l f on this t day of ASHLEY A JAY -09 ATZ A Commission No. 785030 6i MY Commission Expires Notary Public in n e State wa ouly -------------- 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 12h 7��j' Signatur hief or designee V1 i, Tate 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. Approved application DCI report State certified driving record Website update CIeMR IDRWBADGE WL92018awe de DOC Office Use Only 9 -L -1(i Date 04/2018 WWII- 1 1 UUM __. �.... %,H tj1a al l"-' ' ••- '' .. `L,VVL STATE OF IOWA Clra.Pdlinal Mstory Record Cl eck . j Request Vo>rm To: Iowa Division of Criminal Sllbgort Olyerations Hyo ,_„rein. to x 215.L. 7`" iitreer Des Moines, Iowa 50319 (515) 725-6066 (SW 725-6080 IN- DCIAccouptNwnber; 9967-)~ (IfnPPliceble) From: 'Yellow Cab of Iowa City .Iowa City, IA. 52244 (?19) 338-9777 , Phone; .i Fax:(319)339-7302 I am VpAink an Iowa Criminal iiia .1-60ord Cheok on: x,a�. +. Ynwn mnne [&Zrst Name mndmvey)• ' ivZiddlO x4mo amommendrd ' t: uIfey "."4A tar Date of Birth mvldolo )2d or (mmearely) L--C, al•Smuri Number (reeouumdoa /?-//-2 !`j7`j ... ' ale C1Female 3 13'aiverlY{formatlon: Without a -igned walver from fhe subject of the ragpast, a complgre grimlaal history record spay not be releasable, per Code of Iowa, Chapter 692.2. For con lett criminal hfstoryrecord Informadon, as allowed by Inw, always obtain a walver.si nature from the sub'ectiof the re uest. Waiver XeUase: r hero we by l prf dK ion comm shove roquectinP ot[Iolei to oonduot an Town criminal history reooM check with the Division ofCrlmfnel Investlan4icn (DCI). why criminal hhwry dna oonoemin; that iIf mnlnminul by DQ re)e malowell by law. Waiver $ignatrcr : • /� 7 a AAJ,Vl., 1\llV 11lMCeAl�Gll/i!J (DCirwdonly) As of �o anlmlln 'a searck,of the - provided Hama gpri>`Y'pt�e z 8717TE OF IOWA/DPS No Iowa Criminal History Record found wit CI ••m o f Iowa criminal ': o= UG Z 6 2019 ' d Iowa Criminal Idistory Record attached'DI #istory results�.: �jV or ,• a .• Cp11MINAi. i1V!'-"r DCI initials' 1l1c, O�`'`; •.:G, '�'�iqn r"att011 5"pP�o DCI -77 (08/25/10) Received Time Aug.26. 2019 12:57PM No.6414 Sep. 3.2019 12:20PM OC1 IOWA DISCLAIMER No -7475 P. 2/2 This response can only'lncludo puibl(c criminal history data: Under'lowa law, most juvenile records,hre confidentiaC ConflAntlal juvenile court record#, If any, cannot be Included In this response. A siggh6d release authorlzatlon Is not sufficient to obtain this information from.the DlOslon •of'Crbnlnal jnvesflgatlon: In order to request the release of confidential juvenile records; If any, en application mustbe filed pursuant to Iowa Code Rar#ip�,�3.2 147C.d a) Addltlonally, criminal history date concerning convictions for certain juvenile sex offenses can be found on the lova Sex'OffenderRegistry: L11 ://w w:i as offe dente /. Howevar, even. [tiough some Information ls.avaliab/e on this slta,'the actual records forjuvenlles may still be. confidenfin/ and any confidential juvenile records cannot be pi•ovlded with this record. in order to reques[ the release of --- • ---• ^�+ •• W''r+ �+++, aNNu�auvn musC ne 111ep pUrslfant to section 222.147(j 8), Convictions Citation Date w4DOT ACD vmN%f.iawadot.gov County Si;,RTER 1 SIMPLER i COS TOr,AER DRIVER 06/24/2019 Driver P. IdenfLeation Services D72 POEcx9 '.I DosMcinx IAG:3Cni-4209 Johnson Phone 515-211-917.11 Fax 515-239.48a7 Certified Abstract of Driving Record Inquiry Date: 8/26/2019 DL/ID #: 178AN2895(IA) Customer #: 6496003 Name: Pulley, Lamar Class: C ID Status: None Frederick Address: 2114 10th Street PI Audit #: 1782895 DL Status: VAL Issue Date: 05/02/2017 CDL Status: None City/State: Coralville, IA Expiration Date: 12/12/2025 CDL Cert Status: None 522411331 Endorsements: NONE CDL Med Status: None Mailing Address: 2114 10th Street PI Restrictions: NONE Restriction None Supplement: Date of Birth: 12/12/1979 Mailing Coralville, IA Sex: M City/State: 522411331 History Information Convictions Citation Date Conviction Date ACD I Explanation County 0UR 06/24/2019 07/26/2019 D72 Fail to Have Vehicle Under Control Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number IUR 106/24/2019 1121019 IA Name: Pulley, Lamar Frederick DL/ID: 178AN2895 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: Pulley, Lamar Frederick DL/ID: 178AN2895 8/26/2019 Driver & Identification Services Iowa Department of Transporation