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Home My WebLink About19-087IDENTIFICATION NO. j r t (Office se O ly) wi:r ®lief APPLICATION FOR TAXICAB I MOTQQIIEp PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington street Failure to complete the "reau"19, ewt*{ I;result in denial of the application Iowa City, Iowa 52240-1826 "- (319) 356-5040 Last First ,,,,;• (319) 356-5497 FAX r Middle 1. Name(REQUIRED) �� t✓ �.�itti �i{�Et� 2. Address (REQUIRED) �n (5 C"A-; 3. Contact Information (REQUIRED) Email: ;�> i rl, ce(( --ve loo k. row Cell Phone: 855- 2 Z 5Z (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 51,51 Z a 7-Z b. Taxicab Business Name (REQUIRED) N -Z tow Ca-. .1awk L ; 5. Prior experience in transportation of passengers: N a o -C 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? c Tvce of offense Where When What happened to the charge? (Circle one) 7 N IA - Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? ` 4 5 Type of offense Where When sj> eLj .,l What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedlead Gutl Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ti C 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 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 Department of Transportation a valid Driver's license number q C€ 4 L- '7 4 5 C issued on b i 5 u exp rin )L °n �� zc z o I understand that if I falsely answer any questions in this application, that this application may be deniedl. 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, Chapter of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 0"15 7 -- LI \H1fH'f Hf -1! 1\!!ff\y.1fl1H4HHHfHf!lllftNlMfHHflHflf{YfHffHYi'1Hf44HkHHli-11ffHlfH4t4H1ftHfHHH1fi#R1fH1HHlHHIMf},Y\\H STATE OF IOWA ) COUNTY OF JOHNSON I Subscribed and sworn to before me by on this 15+`^ day of ti ov�w,�oc .( 2c1� 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 licensa— SjqWre of Police Chief or designee C-?C�'2p 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. designee Approved application DCI report State certified driving record Website update Office Use Only )1-)8-) Date 066 A(IDRN DGEAPPL92018ame ed DOC 04/2018 AWA( ASHLEY A JAY-PLATZ Commission No. 785030 Notary Public in n e Stat of wa .f\.f...f....+ff.......+.ff.....f..f=++\\.f.\...\\.Hfal.af.f...»................... �ow� miss 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 licensa— SjqWre of Police Chief or designee C-?C�'2p 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. designee Approved application DCI report State certified driving record Website update Office Use Only )1-)8-) Date 066 A(IDRN DGEAPPL92018ame ed DOC 04/2018 11105/2019 1225 Yeiiow Cab (FAX)319 338 27Ue N.uucl002 I STATE OF IOWA, Criminal History Record Check Request Form IDCT Account Ndlrbar•" 996 f -F. Mill or Fax COMR12 d forms to Send results to: Iowa Division of Criminal Investiptiou Name YeUdw4ab of Iowa C Support Operations Bureau, l° Floor 215 E. 70 Street Address P.O. Box 428 Des lt'IejaM Iowa S0319. (515) 725-6066 Iowa aty, Iowa $2244 (515) 7254080 Fax Phone 319 338-9771 Fax 319-359-4142 [.•. 5..,�C � -Li �U1'L1 � � .L'JCL �a�i. y,�r •. �.. ..il :� ;0. � __ 1j �a .. . . l j�1Rlin•n,cI��i1�SM' 6.n.LAI.,y:C� �� S ..Yin . �,��.a[t•�Si tl l� ��5 rl�ihi�IN ice: •1:S11 -'.� .i�. m ri - � t -k•r „y..,, �:�Ya.Tiir•,�.� -,.nnrs�:r.¢uusa_'�JiR�'�.• Iowa C in l History Record Check Results ac 1U1f19TNffaQFolQWA/DA 000\�,�y,d 51 r) o, As of e search of the provided male and date of birth iced N'Q U `9, 5 2019 Crila{A etOry ( ,R9j310 CF{AINAL INVE 0 Iowa al Hi Record found with DCI o' Iowa Criminal history Record attached, DC1 # �y DCT initials DCI -77 (updated 06-26-1018) Received Time Nov. 5. 2019 12:16PM No -7251 Page 102 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 intofmation from the Division of Gr4minal Inver, figatio n- -in -- to request the r-Plessis of confidential 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). X41 DoT SMARTER I SIMPIIR i (US TOMER DRNEN NJ1fV�W.1(�111l��IDQ`��VS po 6oz 9 D 6+f� A, � n Plx:rie !i �'21a-�t 6i a�•Sh6}99a&sr Certified Abstract of Driving Record Inquiry Date: 11/5/2019 DL/ID #: 908AL7650(IA) Customer #: 5774122 Name: Collier, Quentin Class: C ID Status: None Allen Address: 4815 CARDIGAN LN Audit #: 9087650 DL Status: VAL Issue Date: 05/15/2015 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 05/15/2020 CDL Cert Status: None 522459327 Endorsements: NONE CDL Med Status: None Mailing Address: 4815 CARDIGAN LN Restrictions: NONE Restriction None Supplement: Date of Birth: 05/15/1985 Mailing IOWA CITY IA Sex: M City/State: 522459327 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 04 11 2018 104/1312018 S92 Seed Johnson IA Name: Collier, Quentin Allen DL/ID: 908AL7650 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 custodlan 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: pr m �W 11/5/2019 C Driver & Identification Services Iowa Department of Transporation 57�h-_ ic'-j Name: Collier, Quentin Allen DL/ID: 908AL7650 1: 1 L E D 1014 NOV 18 PH 4: 58 CITY CLERK I` W'A CITY. IOWA