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Home My WebLink About21-044CITY 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. 21— 7)q (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 First Middle 3. Contact Information (REQUIRED) Email: Ca��SS % //// �Ce rtr I I. CI)ilell Phone: , fie-,( 4 (All written communication t via email) 4a. Driver's License expiration date (REQUIRED) G// F,3DA23 b. Taxicab Business Name (REQUIRED) k I I nk AJ Cab 5. Prior experience in transportation of passengers: _�ESILW7)aA bElcii CR�I- 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsevi'erev Type of offense Where When _ 0 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? Type of offense Where What happened to the charge? (Circle one) Convicted ismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Y1( 7 Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) 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 certify that I bave issued to me by the Iowa Department of Transportation a valid Driver's license number y) C( A L–aa� issued on fly /P3 expiring on Co, / a — . 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, 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, Cha ter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON S bscrib and worn to before me by N, on day of 1 ASHLEY A JAY -PLA TZ ; ^ o ,. Canmission NO. 7&% Notary Public in d f ate o dwa — July 14,202 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/ _�z 2 2 2- Sig ad ice Chief or designee t 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. 1/4z -I Signat a of City Clerk Or 111signee D to Office Use Only Approved application DCI report State certified driving record Website update CI&VTA%IDRN94DGEAPPL9201Umen0 DOC 04/2018 aatAua.31.2021 3:51PMcab DCI IOWA STATE OF IOWA Criminal History Record Chee Request Form Iowa Dion of Criminal Tnv"dptfoa Supprt Operations Bnrean, I" Floor 115 E 7" street Des Moines, lows S0319 (51}7 '25-6866 (515)Y26-6080 Fax DCIAm mtNumber 9967-F Iowa Criminal History record Chick Results Of appaa+sls) -1y) Send results to: c Name Yellow Cab of Iowa City > -- Addreu P.O. Box 418 - 017 �r i Towa Cfty. Tows S22," - fn Phone (319]338-977 Bu 319-IS94142 DCI -77 (up& ted 06.26-2018) Received Time Aug. 25. 2021 2:38PM No, 1366 `m+nation 5 „s" H+4ryro+xxxxma"+"�" . Page of 2 Iowa Criminal History record Chick Results -1y) As of a search of the provided namc•atd dato of birth mcaled: ` 0 q �"""umexxo+ No Iowa Crun%ual History Recoxd Pound with DCI "„"w" i�' S ��ml.., rQ %7 017 65 m � 0 cn `" 4M "0( ? �• x`06 y 3 o ❑ Iowa Crimloal History Record attaobed, DCI # �a :m �9 'fJ i ! ' :Iowa criminal - t bCI initials '. history results' ` NSI N DCI -77 (up& ted 06.26-2018) Received Time Aug. 25. 2021 2:38PM No, 1366 `m+nation 5 „s" H+4ryro+xxxxma"+"�" . Page of 2 Aug -31,2021 3:57PM DCI IOWA DISCLAIMER No.2114 P. 2/2 This response can only Include public criminal history data. Under Iowa law, most Juvenile records are confidential. Confldentlal Juvenile court records, if any, cannot be Included In this response. A signed release authorization Is not suf7clent 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 Sax ONandor Registry. h . However, even though some Information Is available on this sitw o de o s, the actual records forJuvenlles may still be confldential and any confidential iuvenlle 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 low& Code section 232.147(18). N O CD rr _y ,e D = 0 .� n -- — _-. C- F � , a o_ 0 r�o 410WADOT A0 SMARTER I SIMPLER I CUSTOMER DRIVEN VVWw.lOW8Ci0i gOV Drfvw & wMtakxftn Sanloas PO Box 92041 Des Moines, IA 50306920: Pl orie 516-244-91241 Fax 5 15-239- IM37 Certified Abstract of Driving Record Inquiry Date: 8/25/2021 DL/ID #: 419AF3283(IA) Customer #: 5604041 Name: Guenzler, Hailey Class: C ID Status: None 3UR Breanne 07/04/2018 08/28/2018 D53 Non -Payment of IA Address: 40 Sugar Creek Ln Audit #: 5471415 DL Status: VAL Ste 201 Issue Date: 04/19/2021 CDL Status: None City/State: North Liberty, IA Expiration Date: 03/15/2022 CDL Cert Status: None 523179636 Endorsements: NONE CDL Med Status: None N ,.`E,,, Mailing Addross: 40 Sugar Creek Ln Restrictions: Corrective Lenses Restriction None rA Ste 201 Supplement: r77 Date of Birth: 03/15/1996 Mailing North Liberty, IA Sex: F --I r. -g- City/State: 523179636 r'Cf" rr History Information =u a T. Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Sanctions type Effective End ACD Explanation Occurrence JUR 3UR Suspended 07/04/2018 08/28/2018 D53 Non -Payment of IA IA Iowa Fine Name: Guenzler, Hailey Breanne DL/ID: 419AF3283 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: 8/25/2021 Name: Guenzler, Hailey Breanne DL/ID: 419AF3283 Driver @ Identification Services Iowa Department of Transporation N CJ N r. .aro-... r-- rn A+