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Home My WebLink About20-024alp , CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. ol b s t )C3 t-{ (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 2. Address (REQUIRED) N63 I, 3. Contact Information (REQUIRED) Email: First Middle omC L-1 i(Z 61W1:/. (0tM1 Cell Phone: 31g -5 -?Y- 74f5 Z written communication sent via email) 4a. Driver's License expiration date (REQUIRED) ,,) f_ 7 y— 2 07 -5 b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 7/r' 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? - --1 Type of offense /! Where 1 When F-urrly �/e- v obeg- /;cAr s;Prh J4V 5014 COuLA+� 0T-`67- 701A What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended CMad Guil ther 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /V 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) 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 certifythat I have issued to me by the Iowa Department of Transportation a valid Driver's license number ;E9 `%q I7Sf( issued on _03-)f5-70I%xpiring on Qq- ZH- to23. 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 Ti", Chapter 2, o! ie ity Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 03- ) (P - 2.0W STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by M_cLET 9A _&jQ - S. MAYtK I 1umDu 72942a Notary Public inAd for the State of to this) day of ......+...+..,...+.+t ...+..+...+...++..+.+.+..+.+.++......+.........++.... I have reviewed this application, DCI report, and the State certified driving record of this applicant an¢ have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or uffllfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). i Expiration d of riyer's ' ense U Signature olice 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. of City Clerk or Approved application DCI report State certified driving record Website update Office Use Only —/(o— Date Gcw✓raxiDRivsaocEAPPL9201eamena d.Doc 04/2018 40 C401 4010WADOT SMARTER 1 SIMPLER I CUSTOMER DRiVEN W4'UJ�+.k{DWadCiti.gl�V Driver B IdumNiication Services PO Box 9204 ! Des Wines, IA 6=6 -SO -W Phone 51;x234-9144 1 Fax 51r -7'&-!P,17 Certified Abstract of Driving Record Inquiry Date: 2/17/2020 DL/ID #: 769YY1758(IA) Name: Lottich, Christopher Class: D M14 John None IA Address: 1463 WESTVIEW DR Audit #: 8934357 None D38 Issue Date: 03/18/2015 City/State: CORALVILLE, IA Expiration Date: 04/24/2023 522411031 Endorsements: Chauffeur 3 Mailing Address: 1463 WESTVIEW DR Restrictions: NONE Date of Birth: 04/24/1979 Mailing CORALVILLE, IA Sex: M City/State: 522411031 History Information Convictions Customer #: 1272105 ACD ID Status: EXP JUR DL Status: VAL M14 CDL Status: None IA CDL Cert Status: None Suspended CDL Med Status: None D38 Restriction None IA Supplement: r� Accident C7 Q� r a C Citation Date Conviction Date ACD Ex lanation Count JUR 06/19/2016 07/07/2016 M14 Fail to Obey Traffic Si n Si nal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number JUR 12/22/2008 480109 IA Sanctions Type Effective End - ACD Explanation Occurrence JUR JUR Suspended 03/04/2009 12/21/2009 D38 Fail to Post IA IA Security for an Accident Name: Lottich, Christopher John DL/ID: 769YY1758 M 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: Lottich, Christopher John DL/ID: 769YY1758 I 2/17/2020 Driver & Identification Services Iowa Department of Transporation N Q N CJ 1 �f1 cn 021Feb_2I. 2020 12:-32PMCab DCI IC!^'A � o iNo_ 1226 P., 1/229002 STATE OF IOWA Criminal FListory Record Check Request Form s I As 1=1 Iowa Division of Criminal invasdgation SupporfOperationsBureau, 14Floor 215 E. 7`s 5lxeot Da Moines, Iowa 40519 (5157 725-6066 (515) 725-6oso Fax Lo4.-r,t,, DCI Account Number: 9967-F Cl -wt t Lip kr a search of the provided 23-100 and date of birth No Iowa Criminal History Record found with DCI ❑ IOc9a Criminal History ROcord mttachc& DCI # DCI -77 (updated 06..26..2018) Received Time Feb. 11. 2020 8:48AM N0.0269 ear' filet •n' .r fon Cr;ewaamcp efir - S.. 'retold may r !1„ '�OYd!WfW)<rv7b'pYi4flv4lwot• �•" �br' „ lundilvaid8,feeaa6Klude (fapp&rable) Se na results to' Natne Yelldk� A of Iowa C Address P.O. Boz 428 Iowa City, Iowa 52244 Phone 319) 338-9777 Fax 319-3594142 Cl -wt t Lip kr a search of the provided 23-100 and date of birth No Iowa Criminal History Record found with DCI ❑ IOc9a Criminal History ROcord mttachc& DCI # DCI -77 (updated 06..26..2018) Received Time Feb. 11. 2020 8:48AM N0.0269 ear' filet •n' .r fon Cr;ewaamcp efir - S.. 'retold may r !1„ '�OYd!WfW)<rv7b'pYi4flv4lwot• �•" �br' „ lundilvaid8,feeaa6Klude Page 1 oft X. O t~il 7 0 Page 1 oft ' Feb.21.2020 12:33PM DCI IOWA No.1226 P. 2/2 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 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: httn://www.lowasexoffender.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). N O N O co