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Home My WebLink About20-012IDENTIFICATION NO. L d -- b 1 Z l 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) CITY OF IOWA CITY 410 East Washington street Failure to complete the "required" information will result. denial of the application Iowa City, Iowa 52240-1826 (319) 356-5040 Last First Middle (319) 356-5497 FAX r) -2,c 1. Name (REQUIRED) - V 4 `b� e((i1 2. Address (REQUIRED)) FO Si , 1 r(t r it S-�, -Et 3. Contact Information (REQUIRED) Email: br (All written com1fiu 4a. Driver's License expiration date (REQUIRED) 05//S/ b. Taxicab Business Name (REQUIRED) � �=A 5. Prior experience in transportation of passengers: Z '111< lA Y1-.1 /1i, Pe�7 '.P– "Sia rr--L�,41Ir, c ^Mv Cell Phone: 311-1 ii ion sent via email) ,'2 0,D 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? L� Type of offense Where Whan 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 year o ft1 ic, T_ ype of offense pp Where When What happened to the charge? Circlbwne) j Convicted,/ Dismissed Deferred Suspended Plead Guilty Other / 8. Has your driver's licea uffeur's license been suspended or revoked in the last five years? V0 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 ce i th t y have issued to me by the Iowa D a ent of Transpo ati a valid Driver's license number `,lO issued on �., , expiring o I. I understand that if I falsely answer any questions in this application, that this app cati n 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 Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date < STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by IQ on_.this '7 day of 14ri i 9P -Ab _ in and for the State of I&a �; 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 da of riv s license U :t - 202 �Z—C7�Z®ZPJ Signatur Police 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. or d signee 'IDate Office Use Only Approved application DCI report State certified driving record Website update Ge1k?AXIDRIV6ADGEAPPL92D1 aamendetl DOC 04/2018 WENDY S. MAYER -WI ;Co� iseionTjL 3 in and for the State of I&a �; 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 da of riv s license U :t - 202 �Z—C7�Z®ZPJ Signatur Police 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. or d signee 'IDate Office Use Only Approved application DCI report State certified driving record Website update Ge1k?AXIDRIV6ADGEAPPL92D1 aamendetl DOC 04/2018 , , ww, I-dL# STATE OF IOWA Criminal History Record Check Request Form Maz1 or Fox comnlojd forme 6: Iowa Division of Criminal inveatigation Support Operations Bureau, V Floor 215 F— 71e Street Des Moines, Iowa $0319 (515)725-6066 ($15) 725-6080 Fax DCI Account Number; 9967-F ofappliable) Send results to: Mame 'Yell6tv:Cob oflowe CD Address P.O. Box 428 Iowa City, Iowa 52244 Phone (319)338-9777 Fax 319594142 DCI -77 (updated 06.26-2018) page 1 of 2 Received Time Jan. 29. 2020 1;40PM No, 7110 1% DISCLAIMER This response can only Include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidentlal 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 juvenlle 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. htt ,1AvwwJowasexoffender.com1. 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). CIOWADOT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN. MOONED DrNsr & khwAlI kshon 11IMMas PO Box 92041 Des Milnes, IA 6030&9204 Phone 515.244-9124IFax -515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/30/2020 DL/ID #: 107BB0456(IA) Name: Rickey, Robert Dean Class: C Address: 1121 E MAIN ST Audit #: 9153977 N Issue Date: 06/09/2015 City/State: WASHINGTON, IA Expiration Date: 05/15/2020 CDL Med Status: - Nonce 523532136 Restriction Endorsements: Motorcycle Mailing Address: 1121 E MAIN ST Restrictions: Corrective Lenses ; Date of Birth: 05/15/1971 Mailing WASHINGTON, IA Sex: M City/State: 523532136 History Information Convictions Customer #: 883436 ACD ID Status: None JUR DL Status: VAL M34 CDL Status: None; IA N CDL Cert Status: Non r7 CDL Med Status: - Nonce Restriction NoneJ i Supplement: -fir --9 r• ; m Citation Date I Conviction Date ACD Ex lanation iCountv JUR 12/12/2018 112131/2018 M34 Following Too Close Washin ton IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/12/2018 1090535 IIA Name: Rickey, Robert Dean DL/ID: 107BB0456 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 R. t OF TR{ C�4-4, 'OwQ s _b jw= .I !J Name: Rickey, Robert Dean DL/ID: 107BBD456 1/30/2020 Aa,,Qe� \ Y Driver & Identification Services Iowa Department of Transporation N O N Q �....... ^Y .�� ♦ /'l i na. 71 O'u D �