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Home My WebLink About21-025• IDENTIFICATION NO. _ a I I r (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 Fast Washington street Failure to complete the "required" information will result in denial of the application Iowa City, Iowa 52240-1826 (3 19) 356-SO40 Last First Middle (319) 356-5497 FAX 1 1. Name (REQUIRED) _ �� e rL C4 2. Address (REQUIRED) L'AW-1 pr(S 1^`.0 V-,,. C W 161\ VL -r,,(,IA iI'4� row S Z Z V S 3. Contact Information (REQUIRED) Email j) 0,-VJl 1 ek �0 vnd,; I r cqyl Cell Phone: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) Dl- DLI— Z o 2.i' b. Taxicab Business Name (REQUIRED)_� m, G l e V� 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? llt(? Type of offense Where When What happened to the charge? (Circle one) a N Convicted Dismissed Deferred Suspended Plead Guilty Othef;D 7. Have you been arrested/ charged with any traffic offenses in the last five years? 1yo `. v R 3 Type of offense Where When -E7 0 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? /I/ (� 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) A16 (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 �c�,rtify that I have issued to me by the Iowa Department of Transportation a valid river's license number a 'fa issued on kxpiring on 0'f 202 I understand that if I falsely answer any questions in this application, that this application may be denied. I'agre6 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 of a Notary Public) Signature of Applicant � �� Date k-2 -2=1 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this lic 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 andel ve determined that there is no information which would indicate that the issuance would be detrimental to the safety;; health,?r welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). _ -: r Expiration date of Driver's license /AV? o Z 7— - o SigrratG iceChief or designee 120'/2v Z/ ' 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. Approved application DCI report State certified driving record Website update Office Use Only �F l I ZD.Z Date Cieik MIORNBADGEAPPL92018..nded.DOC 04/2016 .Aro,Apr. 5. 2021 10:16AM,,oro DCI IOWA 3,® ,6664®, on,c2,2a2i oe:oeNo, 0763a23P. 2/3,003 STATE OF IOWA iv� Criminal History Record Check Request Form To: Iowa Division of Criminal investigation Support Operations Hm•ean, V Floor 215 E. 7'i' street Des Moblet, Iowa 50319 (515) 725-6066 (515)725-6080 Fax I am 1•eaueStin¢ an Iowa Criminal f•Tistnry Renard Chnn4.v,• UCl Accounl Number: X1002- F (ifapplieable) From: City ur Iowa City _ City Clerk's Office 410 E. Washington street Iowa Cid, 1A SZ2Q0 Phone: 319-356.5041 Fax: 319-356-5497 N r0 Last Name (Mandatory) First Nam (mandatory) Middle Name (Iia icade \PII\\1U\I11111111111111111p/ll./I As of 4'rJ' 16a1 v�&apd: (DCOae only) Tl D a search of the provided name V-80'l�lb'��i�1i- :o Date of Birth (manaswry) Gender maria=tory)Social Securitv Number (recommended) O C 14114ale ❑Female GI D I —�j (,� ^ Wflilrer Informafion: Wlthoat a signed waiver from the subject of the request, a Complete criminal history record may not be releasable, per Code of Iowa, Cbapter 692.2. Forca. molete criminal history record information, as allowed by lane, always obtain a waiver signature from the subject of the re uart. Waiver Aefeitxe: l hereby give partnisslon for the above requesting official to conduct an Iowa cfiminai histnly focofd check with the Division of Ctin,bld Investigation (DCO. Any criminal history data conooraing me that is maintained by the DCI mey be released as allowed by low. Waiver .S`fa rf nffae: � �4J� Iowa Criminal Historl Record Check Results v_ \PII\\1U\I11111111111111111p/ll./I As of 4'rJ' 16a1 v�&apd: (DCOae only) Tl D a search of the provided name V-80'l�lb'��i�1i- M C' o r. No Iowa Criminal History Record found witli'DCT,•'h 011- `' D c s �.: Js�6ryroy��hr [, ❑ lowa Criminal History Record attached, DCI m DCI initials '� ° 4 rDK 1 .Se ctTO 'leop,rw. 1)U1 -/J (0S//25/1O) Received Time Apr, 2. 2021 9:33AM No. 0589 ,+ Apr. 5, 2021 10:17AM DCI IOWA No. 0763 P. 3/3 DISCLAIMER This response can only include public criminal history data. Underlowa 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: hito://www,iowasexoffender.com/. However, even though some information is available on this site, the actual records forjuveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidentlai juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). C co rn Q� n v o 0 C1JIUWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.lowadat.gov Draw s IIAerNYiCaNOn servius PO Box 92041 Des Moines. IA 5030642004 phone 515-2449124(Fax 515-239.1637 Certified Abstract of Driving Record Inquiry Date: 4/25/2021 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 Citation Date Conviction Date Issue Date: 10/26/2019 CDL Status: None 02/12/2014 City/State: IOWA CITY, IA Expiration Date: 01/04/2027 CDL Cert Status: None 522455614 02/14/2014 02/24/2014 N82 Improper Backing Johnson '" Endorsements: Chauffeur 3, CDL Med Status: None Fail to Obey Traffic Johnson IA Motorcycle Sign/Signal Mailing Address: 1404 PRAIRIE DU Restrictions: NONE Restriction None CHIEN RD Supplement: Date of Birth: 01/04/1970 Mailing IOWA CITY, IA Sex: M City/State: 522455614 History Information P CD ., Convictions Citation Date Conviction Date ACD Explanation County�;0�1 IA 02/12/2014 02/24/2014 M14 Fail to Obey Traffic Johnson -`u Sign/Signal 02/14/2014 02/24/2014 N82 Improper Backing Johnson '" C75- IA cO 03/08/2014 06/12/2014 M14 Fail to Obey Traffic Johnson IA Sign/Signal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/27/2021 1223025 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: Name: Tiet, David Cuong DL/ID: 769YY9401 4/25/2021 1� Driver & Identification Services Iowa Department of Transporation 0 7j � t= Y O