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HomeMy WebLinkAbout19-098CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. P-D�1 (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 3. Contact Information (REQUIRED) Email ur 'seCell Phone: 3)4-47)10D4 All written communi tion sent via email) 4a. Driver's License expiration date (REQUIRED)_._. /z b y J2q b. Taxicab Business Name (REQUIRED) Y-1 U O'J C to'b 5. Prior experience in transportation of passengers: -rA7,L L4 2001- gfece A- 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? _ A/ Q Tvce of offense Where When C--) < — r -- What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty father - 7. Have you been arrested/ charged with any traffic offenses in the last five years? Alt) Tvce of offense What happened to the charge? (Circle one) Where When 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 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 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 herebycertify that I have issued to me by the Iowa Dgpa ent of Transportatio a v lid Driver's license number 01 (s (! £ S7 issued on jZ /l4 jLY expiring on I Z 10 1 4fL 4 . I understand that if I falsely answer any questions in this application, that this application 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, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date Z Z I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by G tpM',P J0 - ) —cAr -cl on this I-;?- day of for �,�lA N I have reviewed this application, DCI report, and the State certified driving record of this applicant and 6ive determined that there is no information which would indicate that the issuance would be detrimental to the safe, health:vr welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). N F_ Expiration date of Dr' er's'aense z- G y- Z o Z% C m M 9CD -7 Signatu Police Chief or designee Date I 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 Gerk/rA%IDRNBADGEAPPLMlftmenOetl.DOC 04/2018 Dec. 3 2019...12:25PM DCI IOWA No. 0354 P. U. 111 .,.. IV ,J.,v cab fAM1993B2,,,,, vv�1008 STATE OF IOWA Criminal History Record Check Request Form Iona Division of Crtmiaal Investigation Srtpport'Operations Burea% IN Floor 215 L 7° street Da Molaq% Iowa 90919 , (515) 7215-6066 (515) 725-6090 Fax I am requcstintt an Iowa Criminal history Record Check on, ACI Account Number. 9967-F Of rppltuble) Solid regalts to: Name Xendw,Ca6 of Iowa C Addreee P.O. Box 428 Iowa City, Iowa 52244 Phone (319)339-9777 _ Fax 319-359-4142 b• R�svy4t ��_'�'�'',ca.:{:.F�,;t� : '�i�(ll:¢.Si�B`�C ... ... dad) r , _., t � .ve- iS' + .'•^ L 1lYt ''' Wena ❑Female? Al'fgmi RR al ts�nY'leas"rgoi �APhYs(o `.id�ordmey . a,Y1u3� t ' foie aFi•;;.... _x n .. . e.A 'A�s._•�3'�5 `i o �dC1Yg5VdstdeYaFelsw"BueY.'oidA�`e'nv.,rw},i� yiicdsb$ckthdlsdA'rldloaoY.r Cri�zn ;)`r � n 4 �Iy�i ` .,.P. '�1aW' � i�Audtll44Lnd �fit'c>n mafuda Iowa Criminal History Record Check Results n„ As of 1 �' 3 it scarob of the provided name and date gf bIrth tpal alck; No Iowa Criminal History Record found with ACI ❑ Iowa Criminal History Itocold attached, DCTl� _ _0_ �T DIV A DCI initials {~`•� •.,; ... ';,,n DCI -77 (updated 06-26.2018) Received Time NDv.25. 2019 1:07FM No. 9737 (1)Cr We only) EOF IOWA/DPS ©V,15 7019 U'R)MINAL INVEST Paga 1 oft Dec. 3.2019 12:26PM DCI IOWA No. 0354 P. 6/6 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 information from the Division of Criminal Investigation. 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). 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). N O C� ♦D n......�. n� <rn N M o� y y- - ��IOWADOT www.iowadot~gov SMARTER I SIMPLER I CUSTOMER DRIVEN DfNst & klentYfOaflOa Smims PO Box 92M I Des Moines. IA 503%.92W Phone 515-244-91241 Fax 515.239-1837 Certified Abstract of Driving Record Inquiry Date: 11/25/2019 DL/ID #: 196AD8857 (IA) Customer #: 3646257 Name: Kacer, Geoffrey Neil Class: D ID Status: None Address: 2110 N DUBUQUE Audit #: 3468586 DL Status: VAL ST Issue Date: 12/14/2018 City/State: IOWA CITY, IA Expiration Date: 12/04/2024 522451624 Endorsements: Chauffeur 3 Mailing Address: 2110 N DUBUQUE Restrictions: ST Date of Birth: Mailing IOWA CITY, IA Sex: City/State: 522451624 NONE 12/04/1975 M History Information CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: N O CLEAR DRIVING RECORD u� n --F1 rrt _ Name: Kacer, Geoffrey Neil DL/ID: 196AD8857 C -)--in N t m 3: Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Depar of 4;mnspoitOEIon, do hereby certify that 1 am the custodian of the records held by Driver & Identification Services, that t4is 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: Kacer, Geoffrey Neil DL/ID: 196AD8857 11/25/2019 Driver & Identification Services Iowa Department of Transporation