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Home My WebLink About19-090CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 22 40-1 82 6 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIREI 3. Contact Information 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 Last First Middle 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) ( A 5. Prior experience in transportation of passer(6ers: N o 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 4 11n 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? ?' ' Type of offense Where -� When qo r taucU Lvg I`ti014� y(16Fi� �f be,'%i ►+��C �1 /2 ' �� ,vo .V -ti c° e e I W h t appened to the c arge? (Circle one) 11 w� f% I I r-� -1S Convicted Dismiss Deferred Suspended Plead Guilty Other 8. Has yc�gr driver s{{I�1eente or chauffeur's license been suspended or revoked in the last five years?I r~�f Pi T.v��pe//'o�t I nsTA/"tVr p WT�iere"' n94 '5t/5 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) AND -1 04/2018 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number !, n �(o issued on -2 > expiring on q I 202 1 understand that if I falsely answer any questions in this application, that this application' ay be denied. I agree that in making this application, 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 provisi of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me byWe Ll on this 2 2 day of ASHLEY A JAY-PLATZ In 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 date9%river's IiCen G% U r? Z 7 NOV 22 2019 ? Citi��l®rl Signakde,906lice thiefordesignee Date Iowa City, Iowa 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. Of City Office Use Only Approved application DCI report State certified driving record Website update Il -aa- �9 Date Clerk/TAXIDRIVBADGEAPM92018aman DOC 04/2018 Slippott Operatloru Bw'ean, P Flaor ..13 L 7a Strw Doc guinea, Tawe sow (516) 725-066 (515)72"OR6 Fx VAAA717J70 L/UO r_vucivu4 STATE OF IOWA II 1 r 1 1 1 1':;'..�. n Request n"••+5 .:.':;/r� Steil_ Atldrecl...F10,Boz 428 CkylIowag4 Phone ��Y) 338 9777 NOV 2 2 2619 Fax 3I9+369�4142 owa �TLa1 History 17eC eck Results. n 1 ` .,„U01 St"a arch o><t%e, providod name:amd darn o£bfi ed l..?rte''% a g' p w� � M • i o }cavi ty Rftord foxmd with DCI IowaG61021 isfo Recordattached,DCS lrb 7CI3nia�nir'en .\•p�IP' �`dP`db ,`ym co SV bCt-Tl (updmd 06 2$-201Sj Page 1 On PR ce i veld T ime rNov. 8. %2619 2:Yl� p'� MNo. 7802 C t, --don 10WA00T Ij SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot,goy Orlym $ IderAftation sarviets 130 Bax 92041 Des Moines. IA 543d6-gMll Atone'. 515-244-91241 Fax 515298-1837 Inquiry Date: Name: Address: City/State: Mailing Address: Mailing City/State: Convictions Certified Abstract of Driving Record 11/6/2019 DL/ID #: Brenneman -Wake, Class: Susan Lyn CDL Cert Status: 1506 Tofting Ave Audit #: Commercial Learner Issue Date: Iowa City, IA Expiration Date: 522409182 12/15/2015 Intrastate Only Endorsements: PO Box 524 Restrictions Date of Birth: Iowa City IA Sex: 522440524 606AH4035 (IA) Customer #: C ID Status: 3953333 DL Status: 06/27/2019 CDL Status: 09/01/2027 CDL Cert Status: NONE CDL Med Status: Commercial Learner Restriction Permit, Corrective Supplement: Lenses, CDL 12/15/2015 Intrastate Only Seed 09/01/1960 F NE History Information 583059 None VAL VAL Non -Excepted Intrastate None Medical Report required 5/2024 SII Fr) NOV 22 2019 City Clerk Iowa City, Iowa Citation Date Conviction Date ACD Explanation County 3UR 04/28/2015 05/26/2015 B61 Violation of Accident Requirements Johnson IA 11/03/2015 12/15/2015 S92 Seed 09/27/2016 NE 01/17/2016 02/17/2016 M14 Fail to Obey Traffic Sign/Signal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number 3UR 04/28/2015 856529 IA Sanctions Type Effective End ACD Explanation Occurrence 3UR 31JR Suspended 07/01/2016 09/27/2016 W01 Habitual Violator IA IA Suspended 07/01/2016 09/27/2016 W01 Habitual Violator IA Name: Brenneman -Wake, Susan Lyn DL/ID: 606AH4035 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: Brenneman -Wake, Susan Lyn DL/ID: 606AH4035 11/6/2019 Driver & Identification Services Iowa Department of Transporation FILED NOV 2 2 2019 City Clerk Iowa City, Iowa