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Home My WebLink About21-003IDENTIFICATION NO. — Ub 1 l (Office Use Only) -4 JAN 13 2021 City �r��tClerk WW�� nvia APPLI!&XWON FOR TAXICAB/ MOTORIZED PEDICAB VEHICLE DRIVER — (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) CITY OF IOWA CITY 410 East Washinglon Street Failure to complete the "required" information will result in denial of the application lorca City. Iowa 52240-1826 13191356-5040 Last First Middle (319) 356-5497 FAX 1. Name (REQUIRED) aa'kr I0r1t'us>_ ILYL 2. Address (REQUIRED) 4311 SILL}" —1`t Nv' I 3. Contact Information (REQUIRED) Email: �iZ1C 1C�4' (L' �Y>1� ' / Cell Phone: 3)1 00 `fOS3'1 (Ail written communication sent via email) 4a. Drivers License expiration date(REQUIRED) 4)S XX �Zq� b. Taxicab Business Name (REQUIRED) '�elln tJ 0— h 5. Prior experience in transportation of passengers: Ube -A(' 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 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? No Type of offense W here When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? Mo 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) PAGE 04/2018 JAN 13 1021 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), es license er I hereby certify that I have issued to me by issued nai0 Department expiring onrtation o J,9l 1 value Id ., I understand thatIfI Baa XX �t IR3 falsely answer any questions In this application, that this application Ciy,Iowa, 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 times with all ofting to this the provisionslication, and I further aof Title 5, Chapter 2, of the City Code. (Neegree that, If ds toion obe signbe a ed in friont of Notaryaver Is rPublic)anted, to y at all Date I" (D Signature of Applicant �` ' n ithRHRfItRHHkHiitf kRl,itHlfitNtRFh44HHtYliHRfiHkHHiiHIIRIHHf fiHHiiktfltlHflifiiMfiiiRliRHYltIIRHiiHH1HIHiiNfilii4ilii'YHY STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of tHiRRifkHii'RiiRRHHHHiH Hi 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 I a `L) 2 -- �� nl.n� Zl Signature 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. Office Use Only Approved application DCI report State certified driving record Website update a„uovcMRN0AWEnMean1s�naed.DOc 0412018 JAN 13 1011 C,JIUWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www-lowadot.goV DrWN B Idwidlieation ssrviars PO Bax 92041 Des Moines, IA 5030&1S2U Phone 515-244-9124 Fax 315-239-1897 Certified Abstract of Driving Record Inquiry Date: 1/6/2021 DL/ID #: 428XX4793 (IA) Customer #: 3171875 Name: Blair, Bonnie Jean Class: C ID Status: None Address: 431 S 7TH AVE Audit #: 2197307 DL Status: VAL Issue Date: 10/02/2017 CDL Status: None City/State: WASHINGTON, IA Expiration Date: 10/21/2025 CDL Cert Status: None 523531519 Endorsements: NONE CDL Med Status: None Mailing Address: 431 S 7TH AVE Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 10/21/1977 Mailing WASHINGTON, IA Sex: F City/State: 523531519 History Information CLEAR DRIVING RECORD Name: Blair, Bonnie Jean DL/ID: 428XX4793 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: 9apP�N4 NT GF Tgs�9O s, Name: Blair, Bonnie Jean DL/ID: 428XX4793 1/6/2021 1/ Driver & Identification Services Iowa Department of Transporatlon OljJan. 7.2D21 10:36AICab DCI IOWA No 9574 P. 1/ ims STATE OF IOWA N 13 2s1i Crlmkal History Record Check Request Form r 47�P,X..S9ui�+ty� j�iII�q; Iow* DMdQa of Crianlnal Inre`tl,,atlua SOP.Ort OPerations Bureau, 1" 1400r 215 )r. 7m Street Deiwoines, Iowa 58319 (516), 7296066 (0172-6p1� Fax DCI Account Number: 9967-F Gf�p9eab:e) Bead cesnitt to• Name Ysn& Dab or Iowa city Address P.O. Box 429 Iowa CRY, Iowa 52244 Phone 71 739.9777 PAU 319-359-4147 -- DCT -77 ,"a F"�o 06 26 2019) Pap I oft eteieed dime Jan. 6. 2021 9:31AM No.9356 OtwJ,a»:w:;101�I �U :11 Al,Cob DCI IOWA 103169I13NJA.°.9514 P. 1 x,004 STATE 01RA10 ',pi Criminal T(istoryMCheck RegndetvYeDiilgvto Irian or rax "unmoral fu= to: Iowa Division of Criminal Investigabon Support Operations Barsau, In Floor 215 K 70 Street Den Moines, fewa .50119 (515) 7256066 (515)72-4-6089 Fax DCI Account Number.. 9967-F (it opponNe) 4and results to: Name Yelow,cab of Iowa 0 address F.0, 801429 Iowa City, Iowa 52244 Pboae 0191336A777 !ax 319A394143 ea -r res 1 aI 1-1 1 ❑Male . M�etaale 148a M 4f188 a: As of t -1 0 a a search of the providui5 c� dI No Iowa Criminal History Record founduV# ❑ Iowa Criminal History Record attached, DC1 DCI initials_ DCI -77 (tWdaed 06-26-3016) Received Time Jan. 6. 2021 9:31AM Ko -9356 rneNmt 56��0�. Page 7 of 2 Jan. 7.2621 10:3BAM DCI IOWA No. 9574 P. 01hr...N. r asdia. s od 0811 dFA1DQI 13M 2�w r "1004 STATE fE �ChWA Criminal History Record Check t Request Yom I Mail or Fax completed forms to: Iowa Dlvlalop of Criminal Invesdgadoe Support Operations banaa,10 Floor 115 1's. 7a Street Des Moiam Iowa 50319 (515) 723 6064 (515) 725-6080 fax DCI Account Natubw- 9967-F 01avali"106l Siad results to: Name Vallft cab of Iowa City Address P.0.9"423 Iowa! 1*, Iawa 52144 Pbone (319)3389777 Fax 319359.4142 CIIUIRaa 11 IS1pC tCCCpCU I.UC "'��yy (D[i ne agaa op As of l A0 a\ a scaroh of the provided n4eOd•'tlatc of blrtli'c Ad: ` a No Iowa Crittival history kowrd found vv h)SCiistorY resultsi 9. m Z I.LL 0 E qj W Q Cr ❑ Iowa Criminal History Record aftcb4 DCI_ �p� h —' U. ion5 1X;l ioitial8� "n �1"n"k," "", to DCI/17 (updated 06-26-10:5) Pate t oft Received Time Jan. 6. 2021 9:31AM No. 9356 Jan. 7.21121 10:38AM DCI IOWA No.9574 P. 4/4 JAN 1 PI f6f AIMER City This response can only Include public criminal history data. Under Iowa law, most C juvenile records are confidential. Confidential juvenile count 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: hYg.-1 www.iowasexoffender.com1. 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).