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Home My WebLink About20-020i 1 l 1 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 3S6-5040 (3 19) 356-5497 FAX %� 1. Name (REQUIRED) 91 2. Address (REQUIRED) a IDENTIFICATION NO. 26'6 2- C) (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 resuft in denial of the application Last 3, Contact Information (REQUIRED) Email:l 4a. Driver's License expiration date (REQL b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of p< First Middle 'ffi-?4a' �d f/tin7t �E JOW 6& ACell Phone: (All Witten communicatier( sent via email) 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where 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? t Type of offense What happened to the charge? (Circle one) W here When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers 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) PdV/VJ (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 I 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 her i that I have issued to me by the IowVii, p mea�tt of Transportatio a alid river's license number b/ 3 issued onl Lxpiring on Oz Z I understand that if I falsely answer any questions in this application, that this tion may be denied. I a re 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 applic4tion, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisiofitle, Chap �Ihe City Code. (Needs to be signed in front of a Notary Public) Signature of STATE OF IOWA ) COUNTY OF JOHNSON ) Date 2,07/ Subscribed and sworn to before me by c�,�e �aN`Z�a r �� on this 1 2 day of ASHLEY A JULFTTZ Notary Public in bQdj&c the Statep : MY Commission Expires _ P v rover Jul 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, healthy welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date%i@ri nse 0 �' ) u — ZoZ- �1 03 6Z -LOM Signa of 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. Clerk or Office Use Only Approved application DCI report State certified driving record Website update Date cieruraxioarva4DGennWLgMJMa ndedooC 04/2018 b. 25. 2020;(j 49PM DCI IOWA fAXXi19�Z.No. 1747 P, ltlz/ooz 'STATE OF IOWA Criminal History Record Check Request Form e Iowa Division of Criminal bvestigadou Snpport Operations Bateau, 1" Floor. 215 S. 74 Street Des Moines, Iowa 50919 (515) 725.6066 (515) 775.6080 Fax HVRrnKt C FF9, I)CI Account Number: 9967-F IMiLWAAJi (ifVpGeablo) Name Yepdw.Cab oflowa City Addras P.O. Sox 428 a Z Iowa Clly, Iowa 52244 Phone 319 8-97 Fax 319.3394142 As of t t d E 5 2021 a search of the provided name and date —No %wa CHM!n4l History Record found with DCI ❑ Iowa Criminal Iddetody Record attaahcd, DDCI DCI in tlalsA� DCI -77 (updated 06;26-20Is1 Received Time Feb, 20, 2020 2:31PM No, 1062 ALM FF77, WwIththe Dion of ',;Vuadt[eMd.thit GAT Inahids wd`onn"11-...1.. ...�w/,.npI(=n onl)p_. CO) �•� �{i 3•� ,�CC�oGG�II_ p S a Z 0=y lrn� O °yghr�4 � LL St- Shp/Ire.... i iG n' _..... Page 1 o!2 �,eb.25.2020 2:50PM DCI IOWA No.170 P. 2 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: hitp://www.iowasexoffender.com/. However, even though some information is available on this site, the actual records forjuveniles 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). ti 0 O o 1 r to p:'-Ta � 3[ L 0 �40IOWADOT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN DrM4r & ICffAftatlon SiM= PO Box 92641 Des Manes. IA 50306-9204 Phone 515-744-91241 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/20/2020 DL/ID #: 198BB4017(IA) Customer #: 3866674 Name: Rothermel, Jeffrey Class: C ID Status: None Alan Address: 2024 SHERMAN DR Audit #: 9749361 DL Status: VAL Issue Date: 01/31/2016 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/16/2021 CDL Cert Status: None 522404768 Endorsements: NONE CDL Med Status: None Mailing Address: 2024 SHERMAN DR Restrictions: NONE Restriction None Supplement: Date of Birth: 02/16/1965 Mailing IOWA CITY, IA Sex: M o City/State: 522404768 ^� History Information CLEAR DRIVING RECORD ---i C-)N cr �? F Name: Rothermel, Jeffrey Alan DL/ID: 198884017 0 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: b�a�N£HT OF Ig4Hg0 O 9r O = Name: Rothermel, Jeffrey Alan DL/ID: 198884017 2/20/2020 Driver & Identification Services Iowa Department of Transporation d115t*10—