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HomeMy WebLinkAbout20-040� r IP '4..4�rtlir®•�� CITY OF IOWA CITY 410 East Washington Street 1=3 City. louva 52240-1826 (3 191 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. 2P)"og O (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 aDDlicatfon Last ;OA& 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQI b. Taxicab Business Name (REQUIRED) First Middle L�,111 u r rre & ri'c l�tf�a✓ �ima�l fcrhJ Cell Phone:_jJR-G2/-761is 1 communic6tich sent via email) 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? A/G 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? _Ak- t/e.5; What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs 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 REQUIRED SIGNATURE AND NOTARY) 0412018 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 ce4i t * I vy Issued to me by the Iowa De art ant of Transportatio a Yaw Driver's license number b 1{/V%rY`y5 Issued on �17expiring on /24L742025 . I understand that if I falsely answer any questions in this application, that this appiicati 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 authodzatlon to be a taxicab driver Is granted, to comply at all times with all of the provisions of Title 5, Ch f 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 on this day of Notary Public In and for the State of Iowa ##*#w**#�"w*****#**R*****#*****####*wa+v###*#***+#*#R*#+nr####*AA* *X#****#*##**##*#***##***w*####*#** 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 date of Driver's license / Z° ) 'Z- - �S Signature of�Chief� nee )� t7 7„ z�D 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, 7pe n -v„ J- exP'W s q/(, / )�- 7-� Signat re of City Clerk or eslgnas 1 Date ...................-..--•----•............ ....... Approved appflcation Office Use Only DCI report State certified driving record W ebeite update CIONTAMORNOADOMPPU20184nanded.D00 04/2018 y. STATE OF IOWA _ Cripui,nsi History Record Check Request Form DCX Account Number. CM �� F MW orat epptiw le) Iewa Dteidon orcrialbal Inveftlgatlon Name p� Support Operadam Sumau,1' F1oor 215 E. r Street Address Da Moines, Iowa So319 -- (51l1725-6066 ��A 14 (515)725.6080 Fax 1 es, —� PLobe me C1ll DQ-77�•r�e uu a n{we (updated 06-26 1 -201g) Pap 1 of 2 Received Time Oct. 2. 2020 3:12PM No. 1743 ---MCI As of (©'llkz 0 uslco Uj N _ _, acarch of the provided name and date of birth revealed; a. 1111elllyse, zk-�,No Iowa CrlwirW Mstory d Record found witb DCT 0iCtim6we. o .s,: •........., b��. •' o w U .. . a o LlIowa Criminal History Record attached, DCI # ,: ^ ` Fw a C p rrimin�� DCJimtiais`. •history insults; o DQ-77�•r�e uu a n{we (updated 06-26 1 -201g) Pap 1 of 2 Received Time Oct. 2. 2020 3:12PM No. 1743 C410WADOT WWIM.IOWadC0Y SMARTER I SIMPLER I CUSTOMER DRIVEN Df%W & w«laneeilat sl tvlaa PO DW OM I D" liloilM IA eo90 AMN pelofle 515444.91241 Felt: 515.2 16V Certified Abstract of Driving Record Inquiry Date: 10/2/2020 DL/ID #: Name: Pulley, Lamar Class: 1782895 Frederick VAL Address: 2114 10th Street PI Audit #: 12/12/2025 CDL Cert Status: Issue Date: City/State: Coralville, IA Expiration Date: NONE 522411331 None Supplement: Endorsements: Mailing Address: 2114 10th Street PI Restrictions: Mailing City/State: Convictions 178AN2895 (IA) Customer #: 6496003 C ID Status: None 1782895 DL Status: VAL 05/02/2017 CDL Status: None 12/12/2025 CDL Cert Status: None NONE CDL Med Status: None NONE Restriction None Supplement: Date of Birth: 12/12/1979 Coralville, IA Sex: M 522411331 History Information Citation Date Conviction Date ACD Ex lanation iCountv TUR 06/24/2019 07/26/2019 D72 Fail to Have Vehicle Under Control Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Pulley, Lamar Frederick DL/ID: 178AN2895 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: 10/2/2020 Name: Pulley, Lamar Frederick DL/ID: 17BAN2895 Driver & Identification Services Iowa Department of Transporation