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Home My WebLink About20-046r CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. 2 C — 0 Ci Le� (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 W First Middle r 3. Contact Information (REQUIRED) Email: y)01\j,. (SL+1A° L Colli PPhone: (°I -11 (All written communication sent via email)` 4a. Driver's License expiration date (REQUIRED) O l b LI 20 2 �T t b. Taxicab Business Name (REQUIRED)1 ; Q13 13 t' 5. Prior experience in transportation of passengers: T 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? A/0 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? &0 Type of offense Where When What happened to the charge? (Circle one) Convicted 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) FOR =1 04/2018 33 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 tome by the Iowa De arten of Transportatio a alid Qriver's license number 6�t y�g4o (issued on D 2 b nen on 1 0 ?o j' 1 understand that if I falsely answer any questions in this application, that this applicati n may be denied. I 6gree 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 Title 5, Chapter 2, of the City Code. (Needs to be signed in front Kopf a Notary Public) Signature of Applicant hew Date O- —702—`� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this Notary Public in and for the State of Iowa day of 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/1,2-7 S�gnatu olice Chief or designee ate 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 designee Iq�2( h 1 ate D �ate�— Approved application DCI report State certified driving record Website update Office Use Only Clerk/TAXIDRNBADUAPPL92018amended.DDC 04/2018 C410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.low8dogov D&W a UNWA litatlen 24"W*S PO Bot 9201 I Des Moines. IA 563069204 Phone' 515-2149124 I Fax 515299- 1697 Certified Abstract of Driving Record Inquiry Date: 10/12/2020 DL/ID #: 769YY9401(IA) Customer #: 2348748 Name: Tiet, David Cuong Class: D ID Status: None Address: 1404 PRAIRIE DU Audit #: 4282788 DL Status: VAL CHIEN RD Date of Birth: 01/04/1970 Mailing IOWA CITY, IA Sex: M City/State: 522455614 History Information Convictions CDL Status: Issue Date: 10/26/2019 City/State: IOWA CITY, IA Expiration Date: 01/04/2027 522455614 02/24/2014 M14 Fail to Obey Traffic Sign/Signal Endorsements: Chauffeur 3, 02/14/2014 02/24/2014 Motorcycle Mailing Address: 1404 PRAIRIE DU Restrictions: NONE CHIEN RD 06/12/2014 M14 Date of Birth: 01/04/1970 Mailing IOWA CITY, IA Sex: M City/State: 522455614 History Information Convictions CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction -- Non Supplement: Citation Date Conviction Date ACD Explanation County JUR 02/12/2014 02/24/2014 M14 Fail to Obey Traffic Sign/Signal Johnson IA 02/14/2014 02/24/2014 N82 Improper Backing Johnson IA 03/08/2014 06/12/2014 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Tiet, David Cuong DL/ID: 769YY9401 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: 41, ��pP^N£Nr OF 7qT 940 N a �A y 7A d = �1 1, Name: Tiet, David Cuong DL/ID: 769YY9401 10/12/2020 Driver & Identification Services Iowa Department of Transporation Fra Sep. 3U,1UZU 1:43YM�prkUCl IUWA MIS 36fi6097 09/26/202009:2sN0'j69P, 2B--focZ FAX STATE OF IOWA A Criminal Ifistory Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Itureau, 1't Floor 215 E. 7u Street Des Moines, Iowa 50319 (515) 725-6066 (515)725-6000 Fax 1 am requestitte an Iowa Criminal ilistory Record Check nn: DCI AccowrtNrupber: 4±003. — F (itappdeabte) From: City of lows City City Clerk's Office 4101;. Washington Street Iowa City, IA 53240 Phone: 319-356-5041 Fax: 319-356-5497 Last Name (mandatory) First Name (mandatory) Middle Name (recommended) ��yy;vrrLw As of "I 30 V--:tc a search of the provided name and date of birth revealed:,: • :, Y 0In _Ml_. m , v' — C, U cr , C.— Date Date of Birth (maodaloy Gender (mandawM - Social Security Number (recommended) �' . f' ' .-n — U i Sep• 30. 2020 1,44PM DCI IOWA No. 7369 P. 2/2 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: http://www.iowasexoffender.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 confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18).