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Home My WebLink About20-038Ir j `III CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240.1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) _ IDENTIFICATION NO. ZO - 038 (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) Faliure to complete the "required" information will result in denial of the application LastFirst }j IT 1Middle rl.7�-, 3. Contact Information (REQUIRED) Email: V1 f,_ t V 4�-C YKE'd,I 4tA 6vore 6nWone: ?i n - 33(^ (All written communication sent via email) - 4a. Drivers License expiration date (REQUIRED) 1,55 3 6`,,Z%37 b. Taxicab Business Name (REQUIRED) Lf e k 1D w 5. Prior experience in transportation of passengers: 9�ff(AC 5 G.. -T 2,13)19 -1617 -79 2 Vf% Davei o 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tyne 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? —T S Type of offense Where When 2v its I't It �o Lf 2b15 U What happened to the charge? (Circle one) Convicte 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) 1h O (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 certify that I have issued to me by the Iowa Department of Tnnsportatl a valid Driver's license number 27 3 % issued on expiring on/.a 3 / I understand that If I falsely answer any questions in this application, that this ap i tion may be denied. I agr i 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, l authorization to be a taxicab driver Is granted, to comply at all times wfti all of the pr!-42� f The apter 2, of the City Code. (Needs to be signed In front of a Notary Public) Signature of Applicat � Date e for Z UZ .� STATE OF IOWA ) COUNTY OF JOHNSON ) Cq Subscribed and swum to before me by on this `c=° day of 0 Notary Public in and for the State of Iowa- - , 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 rest - dents of the City of Iowa City Mlle 5, Chapter 2, City Code). - Expiration date of Driver's license 1 Z" Signatur of FbIlca 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. Office Use Only Approved application DCI report State certified driving record Website update -7 1 4-0 D to CWWTnxcardPrC,E a.22016,r&i�.aooC 04018 ogiSeP.2S. 20201. 9:26A4Cab DCI IOWA FAX gA)MIg336;No.6905 P. 1)M►oo2 STATE OF IOWA. Criminal history Record Check Request Form DCI Account Number: 9967-F (if.ppnwh�.) it or Fax cmpleted forms to: Send results Eo: lows Division of Criminal Investigation SupportOperations Berns, 19 Floor 215 E. 701 Street Des Moines, IoWa 50319 (S15) 725-6066 (515)725.6090 Fax T Mn rw=stin¢ an Iowa Cfiminal ) listaty Recerd Check on. Name Xell6wxM of Iowa Mdran P.O. Box 126 Iowa City, low& $22" Phone (319)33&9777 per 31"594142 DMM (updawd 06-26-2018) Pafo 1 of 2 Received Time Sep.24. 2020 2:14RM No.6640 i+w a uwa a.a.ae W4wp 11a l AjwVZkJMVMUAsa, Lel. / 6-e _ Yv apt,-- As ..r,.:., i �t.. -_� • ave ; 'Et`i T.00lroenma $Z-�&U--1%-3 r ' �lVlale ❑Female _ - ,. � �•e�? t7feoitti lcay . .0yhMi. ' w -~r a y`t•.e4 4�4 rn ,Giei .7 O v to rt� T bt. • D ,V .r DMM (updawd 06-26-2018) Pafo 1 of 2 Received Time Sep.24. 2020 2:14RM No.6640 i+w a uwa a.a.ae W4wp 11a l AjwVZkJMVMUAsa, d1•y 7i yM Mi» As of of the provided name and date of birth revealed d rn No Iowa Criminal History R000rd found with DCI - O v to rt� T D ,V ❑ Iowa.Crlminal History Record attached, DCI # c c �j rn Go .DCI initials l `- —CnI DMM (updawd 06-26-2018) Pafo 1 of 2 Received Time Sep.24. 2020 2:14RM No.6640 Sep -28-2020 9:27AM DCI IOWA No -6905 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 flied 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., htta://www.lowasexoffender.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 confldentlal juvenlle records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). r� c� "— ry r— 0 C�'OWA DOT i wadot. v SMARTER I SIMPLER I CUSTOMER DRIVEN mow' Cl 9p Drkw S Idsraification Ssrviees PO Box 92041 Des tMnm IA 6030&4201 PhoM 515-244-9124 1 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/16/2020 DL/ID #: 153BB2737(IA) Customer #: 4101693 Name: Dodemr, Dennis Class: D ID Status: None Woods Address: 3212 HASTINGS Audit #: 9921851 DL Status: VAL AVE Issue Date: 04/08/2016 CDL Status: None City/state: IOWA CITY, IA Expiration Date: 12/01/2021 CDL Cert Status: None 522454021 Endorsements: Chauffeur 3 Mailing Address: 3212 HASTINGS Restrictions: NONE AVE Date of Birth: 12/01/1948 CDL Med Status: None Restriction - None Supplement: ... i Mallin p IOWA CITY, IA Sex: M _ "') _O I i . City/State: 522454021 O --> History Information w c� Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 111/15/2014 827794 IA Name: Doderer, Dennis Woods DL/ID: 153BB2737 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: Doderer, Dennis Woods DL/ID: 153BB2737 9/16/2020 oc9 a4�� Driver & Identification Services Iowa Department of Transporation