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HomeMy WebLinkAbout19-086IDENTIFICATION NO. K D8 (.0 ^ 1 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m, to 3 p.m., Monday — Friday) 41 0 East Washington Street Failure to complete the "required" information will result in denial of the application Iowa City. Iowa 52240-1826 (3 19) 356-5040 Last Firs (319) 356-5497 FAX Middle 1. Name (REQUIRED) I✓1 2. Address (REQUIRED) A,p 4 I J 3. Contact Information (REQUIRED) tr(,wrn Cell (AII written communication sent via email) 4a. Driver's License expiration date (REQUIRED) �V /— 7 — / b. Taxicab Business Name (REQUIRED) o /1-h 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? X12 NOV 18 2019 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? Where When kr o I l Ul 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? 14r) 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 04/2018 q/ 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 ertify that I have issued to me by the Iowa Department of Transportation a valid river's license number n �Gi y issued on 1 107- l9 expiring on I understand that if I falsely answer any questions in this application, that this application may be denied. I agree that in aking 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 prol!"s of Title 5, Chagjjr 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicanQ�z 4-� oc- .Y Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by K?N (� Vyl 4 S on this �— day of ASHLEY A JAY-PLATZ Commission No. 785030 Notary Public in n for e_Stak6 o Iowa rows 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 Driveroi e 3- 72c> z i Signature o ice Chief or designee 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. Clerk �r designee Approved application DCI report State certified driving record Website update Office Use Only 1-19-1`I Date NOV 18 2019 City Clerk Iowa City, Iowa Ge1k(TMORNaADGEAPPL9201 8em..w.Doc 04!2018 10118/2019 12:59 Yellow GAD QW)JIV43UVIA Y.UUZIUUL , STATE OF IOWA Criminal History Record, Check Request Forth DCI Account Number: 9967-F (if wpUwblo) MH?I_or Fax oomuletod forms to: Iowa Dlvlalon of Criminal Investigation Support Operations Bureau, V Floor 215 E. 7' Street Doe Moines, Iowa 50319 (515) 725-6066 (515) 725-6080 Fax I am recuestine an Iowa, Criminal Hlstory Record Check on: Send resnits to: Name Yellow Cob of Iowa City A,ddrea P.O. Sox 429 _ low% City, Iowa S2944 Phone (319) 3389777 Fax 319-359-4142 .: r- .a- as L D . m (5 N ��9Jt. Pf�.�. ;y ':' .:"<;�< ;SA.�i:ed-�.. ��•.. q'r5`'=„s1S, O�3 ( ale ©FemaleS2 11. tt pper�. >aiay y.••y N•Av�e •(- ��.j'�'K i.w ,�1�� � ��ri'`•#i..•� �1�^1 je ,`i':�11i`�uA}�)': f.'' N 'P � y .'.Y. �, �':. i�!a�a,�• .7r,�tjF,*r � ��r 1h `4iyrr .��,z:'.r-,:.' n.�lT.: �iiy .":^:u� ;. yn. .�1. 'i '� r�.ti,A'"w :, �- at- iiLsFEIRS£,�r � � � rto u,4 Y. a9P��°+6'A9"l:�ea'�i o5efA�'Mydi $6 DIi')M11dMt<f `'`''`�� .� �Ka .�.�ur�1i f�t�v' �. ., as,aiiov�CdLylaW Iyldderati�lh(t gaiii'014dB .a7AK. ----- --- ------------- _ As of d' — a ectrch of the provided name and date of birth d_ T 'P �d Iowa Criminal fTistory Record found with DCI '• n2� ^r�i� 0 �` a ❑ Ionia Criminal History Record attachai, DCI # peK, q .'' oh �C�Gi IUinii�Po�U° (j DCI initials�l�� DCI -77 (updated 06.24,2019) Ro o{�od Time 11pf 14 1610 19•daPM NA dd91 NOV 18 1019 City Clerk Iowa City, Iowa Pogo I of 2 C4610WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN WWW.IOWBdOt.90V Driver 6 IdentlBealion Services PO Box 9204 1 Des Moines. IA 50306.9209 Phone. 515@49.91241 Fax 515-239.1837 Certified Abstract of Driving Record Inquiry Date: 9/27/2019 DL/ID #: 267AD6694 (IA) CDL Permit Class: A Customer #: 5430186 Class: D CDL Permit Issue 09/27/2019 Date: Name: Holmes, Kevin Earl Audit #: 4202433 CDL Permit 07/16/2020 Expiration Date: Address: 924 23RD AVE APT Issue Date: 09/27/2019 CDL Permit Passenger, School Bus Endorsements: Expiration Date: 11/23/2021 CDL Permit Corrective Lenses, CDL Restrictions: Intrastate Only, No Class A Passenger Vehicle, No Passengers In CMV Bus City/State: CORALVILLE, IA 522413107 Endorsements: Chauffeur 3 ID Status: VAL Mailing 924 23RD AVE APT D Restrictions: Commercial Learner Permit, DL Status: VAL Address: Corrective Lenses, CDL Intrastate Only Restriction None CDL Status: VAL Mailing CORALVILLE, IA 522413107 Supplement: CDL Permit Status: LIC City/State: Date of Birth: 11/23/1972 CDL Cert Status: Excepted Intrastate Sex: M CDL Med Status: None History Information Convictions :station Date Conviction Date ACD Explanation IUR County )1/01/2017 02/13/2017 592 Speed WI Name: Holmes, Kevin Earl DL/ID: 267AD6694 (IA) Pursuant to Iowa Code 4321.10, 1, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that 1 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: a ryw 4q 9/27/2019 � s ��^^yy yy^^ //l/Q/1 OV Driver & IdenD�n Services rF "LED Iowa Department of Transportation NOV 18 2019 Name: Holmes, Kevin Earl DL/ID: 267AD6694 (IA) City Clerk Iowa City, Iowa