Loading...
HomeMy WebLinkAbout21-031I � t CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED, IDENTIFICATION NO. 021-0:3 Il (Office UseOnly) t" APPLICATION FOR TAXICAB_I 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 First Middle 3. Contact Information (REQUIRED) Email: Wrf-a2y a&he)OLa Cell Phone: %09 20 4S-03 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) l Z- /13 / ZoZ ;E b. Taxicab Business Name (REQUIRED) 7C L 1 5. Prior experience in transportation of passengers: CAU F0;9—Mi A- C IIJJt- VAT I ot,1 Co21Ps 1" fWOP-ri t- G fA CXP� F acl,1(7 r -) 0 �KOJ EY11e/LG6 &Y Y iW},)SeD Z-- of 4`5 11- 6. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? ►JO Tvoe of offense tJ I, What happened to the charge? (Circle one) Where When 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. Hav@ you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) p) (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 regrteat) nth I re certify that I have Issued to me by the Iowa p rtment of Transportali n valid Driver's license number ��TO© 43 issued on 3 expiring on �ji31 . I understand that If I falsely answer any questions in this application, that this application may be denied. I agree that in making this application, 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 f f oo,�Title 5, Chapter 2, of the City Code. (Needs to be signed. -In- front of a Notary Public) Signature of Applican� V f(L�kCc i Date / 7441,0 STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by on this day of Notary Public In and for the State of Iowa 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 12 %d 2 i 6Z2y/zo SI ature of Police Chief or designee T 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 DAT15 NWTED BELOW. Approved application DCI report State certified driving record Website update Office Use Only (o ;i-5 --"—I Date C1arWTAXIDRNOA0GEAPPLW01Bam ided,000 04/2018 06,. .13.20211,10:22A4C* DCI IOWA FA="=]No.15B3 P. 11021002 STATE OF IOWA r! `"Q '' Criminal History Record Check Request Form, ., 2y'# t 2' Mail of Fax coianletod foils• tt� lona Division of Criminal Investigation support OParatlona Burney P 11UOr 215 1L 76 street Des Moines, Iowa 50319 (515) 72S 6066 (515) 725-6080 Fax DCI Account Nitm¢er: 9967•F Sind- '' U(YppLwbld Lam: Puna YeBow Cab orlowa city A"M 11.0. Son 126 Iowa Gty, Iowa $221/ Phone (319) 336-9771 Fax $I9-35OL414 As of ' .)— , a search of the provided name i El No Iowa Criminal History Record found with Iowa Criminal history Record attached, DCI. DCI initials 0C MI -77 (updated 06-26-2018) Received Time Jun. '7. 2021 10:17AM No, 1313 •; /Oka •. a i h2s�Ory e not rZfKon Se -0 40 (M we o*, ) TE OF IOWA/DPS JUN 17 2021 : CRIMINAL INVFST Page I of' - Jun, 18.2021 10:22AM DCI IOWA No. 1583 P. 2 DISCLAIMER` This response can only include public criminal history data. Un(�eflowa 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., hits://www.iowasexoffender.com/. However, even though some information Is available on this site, the actual records for juvenlies may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenlle records,lf any, an application must be filed pursuant to Iowa Code section 232.147(18). C4A04001 ,w.iowaddt. o SMARTER I SIMPLER I CUSTOMER DRIVEN ^,g Drfvef a lE haii ailon 6:ervkas PO Box 92061 Des Molnm IA 503069204 Phone 515214-91241F.ak SIS239 IW0 Certified Abstract of Driving Record Inquiry Date: 6/17/2021 DL/ID #: 539AT0043(IA) Customer #: 7120178 Name: Harvat, Jacqueline Class: C ID Status: None Renee Address: 956 Boston Way Apt Audit #: 5390043 DL Status: VAL 5 History Information CLEAR DRIVING RECORD Name: Harvat, Jacqueline Renee DL/ID: 539AT0043 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: Harvat, Jacqueline Renee DL/ID: 539AT0043 6/17/2021 Driver & Identification Services Iowa Department of Transporation Issue Date: 03/17/2021 CDL Status: VAL City/State: Coralville, IA Expiration Date: 12/13/2029 CDL Cert Status: Excepted Intrastate 522411206 Endorsements: NONE CDL Med Status: None Mailing Address: 956 Boston Way Apt Restrictions: Commercial Learner Restriction None 5 Permit, Corrective Supplement: Lenses, CDL Intrastate Only Date of Birth: 12/13/1959 Mailing Coralville, IA Sex: F City/State: 522411206 History Information CLEAR DRIVING RECORD Name: Harvat, Jacqueline Renee DL/ID: 539AT0043 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: Harvat, Jacqueline Renee DL/ID: 539AT0043 6/17/2021 Driver & Identification Services Iowa Department of Transporation