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Home My WebLink About21-020�, IDENTIFICATION NO. 21-02-0 _ l (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) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required"Informatlon will result in denial of the application lona City. lotea 52140.1826 (3 19) 356-5040 Last First 1319) 3S6-5497 FAX Middle 1. Name (P.EQUIP.ED) 2. Address (REQUIRED) bb ,7"Shlr)Qlon :Z0, r X/35 3. Contact Information (REQUIRED) Email: %/ h�V t d �Co FM Cell Phone:.3I9— 7 1� 1— 333,6 (All written comrvrunicati6n sent via email) 4a. Driver's License expiration date (REQUIRE ),S h b. Taxicab Business Name (REQUIRED) yalinid 5. Prior experience in transportation of passengers! Lti N r- 8. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? _ D Type of offense Where When 0 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Ottiar' 7. Have you been arrested / charged with any traffic offenses In the last five years? y N 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? A)O Type of offense W here When 9. Have y 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 ANn NnTARv1 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 erleby certify. that I h ve Issued to me by sthe ued on D rt ent P rTl g onoU� n a valid Driversunderstand that If I �p�rfi �Antp/-this - falsely answer any questions in Is applicatlOn, that this ap City, Ion, in theird sic etion, to examine any i amend all records o nd consent to allow agents or employees of the City of Iowa City, documents relating to this application, and I further agree that, if authorizadon to be a taxicab driver is granted, to comply at all times with all of the provis' ns f Title 5, C apter 2, of the City Code. (Needs to be signed in front of a Notary Public) Dat / O � Signature of Applicant #N#[ft[ftftflN#fiR#NN#NffNYNf #!N#NNNNYNRNf YN#fN#if NN[##ff NNSf ih1NYYff#iNfitt*H#fNNfiYN*NY#Yf11N#NYf N#RNNNfN#N STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of I have reviewed this application. DCI report, and the State certified driving record of this applicant and have deiRmined that there Is no information which would Indicate that the issuance would be detrimental to the safety, hego!?r welfare of redlf dents of the City of Iowa City (Title 5, Chapter 2, City Code). ri r Expiration date of Driver's licenseCD i�� y/?/2� 2 i w Sig ure fo Police Chief or esTs gnee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE ATAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Sig ature of City Clerk o des gnee Date Ni*tfHi}1N*R*N*Ni*N4kt*tkk*NtHkNNt*t#i4#fiNNk#4*Nf*iN4Nt*tttik**fkit44#Y**itft**kf tt*f ***k4iN}f**kfikk*f *kYt#Hi#*Nk#t*i*#Nf#f Office Use Only Approved application DCI report State certified driving record Website update CWJA DRNBADGEAPPLWD18a nded.DOC 04/1018 pslMar.23.2621.19:27AMC@b DCI IOWA fA)P1$M2N0.9143 P. 1/2M STATE OF IOWA Criminal History Record Check RegnestForm Iowa Divbion of Criminal In•eatigation Support Uperatioaa Durran, l^ Flour 215 E 76 Street Dm Motaear Iowa 50319, (515)'123.6066 (515) 725-6090 ?ax R etn-d -' DC1 AccountNumber.. 9%7-F OfappaabN) Send results to: N Nome Wow .Cab of I_ owa ipt- Address P.O. Box 418 - -i M Iowa Iowa S22�t r" Phone (319)338'-9777 Y"319.359-4142 �— r OFemale AS of , a searcb of the provided name and �V Cb Iowa Criminal History R000rd found witb DC1 ❑ Iowa Criminal History Record attached; DCI 1)C7 initialsozi— - DC: -77 (updated 06-26-2018) Received Time Mer. 18. 2021 3:1''x' Nc.664i0 iMald l_._ .LMVi!� bi 'rd mp 1b�•H�1r • , ;.;. Page 1 of 2 Mar, 23.1021 9:28AM ON IOWA No.9143 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: htfo://www.iowasexoffender.co . 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). G ti ti 1 —r t 0I o.�a _a W ti C A061 410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN uwvw.iowadot.gov Drtref S Ider011sation SNvk43 PO Box 92041 Des Milnes, IA 503065204 Phone 515-244-91241 FaX 515-239-1637 Certified Abstract of Driving Record Inquiry Date: 3/18/2021 DL/ID #: 107BB0456(IA) Name: Rickey, Robert Dean Class: C Address: 1121 E MAIN ST Audit #: 4541748 Issue Date: 02/07/2020 City/State: WASHINGTON, IA Expiration Date: 05/15/2028 523532136 Endorsements: Motorcycle Mailing Address: 1121 E MAIN ST Restrictions: Corrective Lenses Date of Birth: 05/15/1971 Mailing WASHINGTON, IA Sex: M City/State: 523532136 History Information Convictions Customer #: 883436 ID Status: Nor2 DL Status: VAL— CDL Status 7 Nox/Tb CDL Cert Status; _ NonS p CDL Med Stat s .'=None Restriction - No 6 ! Supplement: — i.J ^moi Citation Date I Conviction Date ACD I Explanation iCounty 3UR 112/12/2018 112/31/2018 IM34 iFollowing Too Close Washin ton IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 12/12/2018 1090535 IA Name: Rickey, Robert Dean DL/ID: 107BB0456 Pursuant to Iowa Code §321.10, I, Darty 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: 1 Ur py. HyS 4 R. Name: Rickey, Robert Dean DL/ID: 107BB0456 3/18/2021 Driver & Identification Services Iowa Department of Transporation V O i•i-.�. I o W w