HomeMy WebLinkAbout19-097CITY F IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
2. Address (REQUIRED)
IDENTIFICATION NO
I q-og7
(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 wili result in denial of the application
Last First Middle
3. Contact Information (REQUIRED) Email:
4a. Driver's License expiration date (REQL
b. Taxicab Business Name (REQUIRED)
via email)
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? h
What happened to the charge? (Circle one) o
Convicted Dismissed Deferred Suspended Plead Guilty :Other z
7. Have you been arrested / charged with any traffic offenses in the last five years?
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?
Type of offense Where When
i
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
PAGE FOR REQUIRED SIGNATURE AND
04/2018
y
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 here yt at 14fe issued to me by the Iowa_ D partment of Transportation valid Driver's license number
1 0 issued on 2 I1 expiring on 6 /Z . I understand that if I
falsely answer any questions in this application, that this applicati n may be denied. I gree 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 provi ' n of Tile 5Chapter 2, of the City Code. (Needs to be signed in (front of a Notary Public)
Signature of Applicant Y Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn before me by Jou L; ti, �V�_ J Q< < Q on this day of
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, ,healthy welfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration date of Driver's license q /
Si tyr /oo lice Chief or designee
4
)z/ 1 /I �
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.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
aWTM1DR 1BADGEAPPl9M18emende .DOC 04/2018
• Dec. 6. 2019 12:28PM DCI IOWA No.0971 1 2'3
171Uueuiu la:4i reaowCab ff)OMS93BZnw r.uu;1003
AI
STATE OF IOWA A
Criminal History Record Check
qw Request Form
P
Mail or Fax comnlgted forms to;
Iowa Dividon of Crbninat Investigation
Support' Operations Bnreaa, l" Floor
215 B. 76 Street
Dem Moises, Iowa 50319
(515) 72$-6066
(415)725.6000 Fax
1101 raouosdn¢ an Iowa Criminal Hlatom Record Check en:
DCI Account Number; 9967-P
(ifapp8nble)
Send results to;
Name XeUOw,Ca6 of Iowa Cft1•
Addrw P.O. Box 428
Iowa City, Iowa 51244
V
Phoac (319)338-9777
Fax 319,359.4142
` lows Criminal History Record Check1fsults,, - MCI a0mftl,7
e search ofthe providednad649d•ijat*' f irth isve!4$A OF IOWA/DPS
V �iv c
'n D CO22019
No Iowa Crimin�l history Ae>cord fotlad wffli
�� '•. : "Y; Ddt% OF RIMINAL INVEST
❑ Iowa Crintinal History Recald attached, DCI
DCI initials��
DCI -77 (updated 06-26-2018)
a
Received Time Dec. 2. 2019 1:37PM No.0162
Pato 1 of 2
�.`"` +� ;�'dtiob��'�*•�� ;ur,�y�-$I��n�IB;!(ie`o8miri�fdadi'•..;.�:
f7
V i,CJ& cz
�y
v f15�� lV'."' ;•:)v4."7+ � v !n'YICd1a2e0ed
�j
1 ` 1
G, p� /�
aie Female ?"II� - 12 ' 2-
2! f
raaY90
*0"* �j
1 \ \� �,Y� �,�rhx�1�'f�
iwm
n4fgt 7�i s:
.-i
�Td� lj � y� T�a� -' ' f ��'iii±•• 'tom .A •-r..Ii45 SJ P'i'- iaJ. rte.` i'� �
�•! .i 2' ..
nom, ywx '.n•� s
ttin -".�a � ... . .
C�.iEF r( �} '•
Kl���6
�,��- � n�.uy,J+
� Y� fi�o19�j �@,ni��j.�°� '1k C'.1JtWa021'er.t .
^„YvX,ypE.rdtanoi hioloa�.
�
� r � 1 .
FI 4
fF} d ` ^
a .el• ✓ n •. 1i': �
f.:,h e G 't �rA �^�+y+/��?.�
�S &' r�rY �" i,'•rb0.""j ��a'� *i't ^ "e^y!r !•
` lows Criminal History Record Check1fsults,, - MCI a0mftl,7
e search ofthe providednad649d•ijat*' f irth isve!4$A OF IOWA/DPS
V �iv c
'n D CO22019
No Iowa Crimin�l history Ae>cord fotlad wffli
�� '•. : "Y; Ddt% OF RIMINAL INVEST
❑ Iowa Crintinal History Recald attached, DCI
DCI initials��
DCI -77 (updated 06-26-2018)
a
Received Time Dec. 2. 2019 1:37PM No.0162
Pato 1 of 2
?COn 10WADOTI www.iowadotgov
SMARTER I SIMPLER I CUSTOMER DRIVEN
Drina & IdWAYlcadon sarviiees
PO Box 920! I Des Mines. IA 60306-9204
Phone'. 515-24491241 Fax 515-239-1897
Certified Abstract of Driving Record
Inquiry Date: 12/2/2019 DL/ID #: 883AL8306(IA) Customer #: 6306462
Name: Rice, Dominick Earl Class: C ID Status: None
Address: 502 5TH ST APT 7 Audit #: 8838306 DL Status: VAL
Issue Date: 02/12/2015 CDL Status: None
City/State: CORALVILLE, IA Expiration Date: 09/14/2021 CDL Cert Status: None
522412318
Endorsements: NONE CDL Med Status: None
Mailing Address: 502 5TH ST APT 7 Restrictions: NONE Restriction None
Supplement:
Date of Birth: 09/14/1984
Mailing CORALVILLE, IA Sex: M
City/State: 522412318
History Information
Convictions
Citation Date
I Conviction Date
ACD
Ex lanation
Coun
3U
07/02/2015
08/12/2015
592
Seed
Johnson
IA—
c�
Accidents - Accident involvement indicated does NOT mean the individual -was at
fault or given a citation.- v i-
-7
Accident Date
Case Number
�' N
31.1111.
03130/2015
852479
IA m
Name: Rice, Dominick Earl DL/ID: 883AL8306
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: Rice, Dominick Earl DL/ID: 883AL8306
12/2/2019
Driver & Identification Services
Iowa Department of Transporation
N
O
CJ
`n
C'
`;
r
C-) <
-
-
.<r
m
C:)�
a
tV
Q