The URL can be used to link to this page

Home My WebLink About21-043� r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 3S6-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED', IDENTIFICATION NO. (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 aoolication 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: Phone: (3/ 9) 354 — 7 52 9 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tvce of offense Where When n 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? V I e5 A What happened to the charge? (Circle one) nvicte Dismissed Deferred Suspended Plead Guilty Others Has your driver's liter a or chauffeur's license been suspended or revoked in the last five years? / y o 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) 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). 1 hereby certfy that have issued to me by the Iowa Department of Transportation a valid Driver's license number -40 4c{ 3lZCo issued on Si i(al ZI expiring on Li ISO 1 29 . 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 provisi n of Title 5, Chapter 2, f the ity Code. (Needs to be sigGe�d in ont of a Notary Public) Signature of Applica Date / 2/ STATE OF IOWA ) COUNTY OF JOHNSON S= and sworn to before me by )kgk0t cC a_. on this A c.� day of 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 �/ �O/Zo z 9 T i turas o ice Chief or designee d -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. of Office Use Only Approved application DCI report State certified driving record Website update Date Clerk/rAXIDRNWGE PPL92018am nde DOC 04/2018 ASHLEYAJAY-PLATZ Commission No. 785030 my commiss July 14, 2023 c.� day of 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 �/ �O/Zo z 9 T i turas o ice Chief or designee d -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. of Office Use Only Approved application DCI report State certified driving record Website update Date Clerk/rAXIDRNWGE PPL92018am nde DOC 04/2018 M� AL STATE OF IOW) Criminal History Record Request Form DCT A= Mail 9l Fax cgmple .d forM to Send rasul Iowa DivCriminal Iuvestigation Name (ision of SupHrt Operatlotu Bureau, 11 Floor • �; . r -�;., r"!... ,nr:x�'^� (# �' _ iad 218 EII. 74 Street Address Des r4olues, loom 50319 (515) F25-6066 S 1 ` .1 -'.�"! 'M t'M�141TI1� INIX (515) ZS -6080 Fax Ai1k4s� e' n� Y " ♦ • s� k sg_ f o'�L�'�s� �'r •��s �. ' Phone Paz I am reuuestiaa an Iowa Criminal History Record Check on: 319-359-4142 •n - .c•w.: '�Ti4f11@ ev o e�rti T J 2,CGdV\- —ga A A Da't¢'t� ;� • �; . r -�;., r"!... ,nr:x�'^� (# �' _ iad Q 12 ep J S 1 ` .1 -'.�"! 'M t'M�141TI1� INIX Y5rvt. Ai1k4s� e' n� Y " ♦ • s� k sg_ f o'�L�'�s� �'r •��s �. ' R `'�` t. 1 a oved.r�1'e'`�'av@i aul�dMMn. :'R'�'1f O y l•N'i{ '. � �...i4�jYp�%M ..: �+s�-'S�'iy?•,,�.Ju �'ri 9'�i �i�: i•A�C r� �is. .ja �.el':•,•'�-.,�9'.: � N ;^....'. '1 t%1} rel !1�'1 ?moi ��i) i . Y' �Y✓ �,{�. j. "Y l�•� Ai .- i 1 `�r''Q �Y}4N.'u'^�`- �+ O 0 � �'• '�' �� aCleaeeiade �� skd'S '2r=:, J � ' -'� ° .' :,rt, h2'J� .�� nrt +',en 9 • i � . i Z DCI initials Received Time Aug. 31. 2021 5,29PM Na 2139 lUWU %�ruulllal nWwryLCCvyru $ggxkAtlhS9J7SU1A re•S (DQy) As of a �•I, wa i P mal a search of the erie °qq 61 :a provided a �hi3WI 2 Q 12 No Iowa Criminal History Rocord found with . � g o • • ��'�rbJ�°J'��xatiolt St oar` O w a ! ,qrN/ggtlHeeNa1e00Pa Iowa Criminal History Record attached, DCI # FW" r t) ' LL. O N i Z DCI initials DCI -77 (upd 66L26-2018) 1 4 � Pace oft Received Time Aug. 31. 2021 5,29PM Na 2139 l DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential, Confidentiaijuvenile 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: http://www.iowasexoffender.com/, 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 confidentiai juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). N O C _ N �410WADOT wwwi wad v SMARTER I SIMPLER 1 CUSTOMER DRIVEN 0 0 g0 DrIvef & IdsMaisatien aNvim PO Box 92641 Des Moire & IA 50MCMU phone 515-244-91241 Fax 5152391837 Inquiry Date: Name: Address: City/state: Certified Abstract of Driving Record 9/1/2021 Koedam, Jeremy Jones 308 W Linn St Lone Tree, IA 527557780 Mailing Address: PO Box 376 Mallinp Lone Tree, IA City/state: 527550376 Convictions DL/ID #: 769YY3726 (IA) Customer #: 677799 Class: D ID Status: None Audit #: 5386280 Issue Date: 03/16/2021 Expiration Date: 04/30/2029 Endorsements: Chauffeur 3 Restrictions: NONE Date of Birth: 04/30/1982 Sex: M History Information DL Status: VAL CDL Status: None CDL Cert Status: None,, CDL Med Status: None rn Restriction - Norte Supplement: ` 10 s ,v r Citation Data Conviction Date ACD Explanation County IUR 07/16/2017 08/03/2017 M14 Fail to Obey Traffic Johnson IA Sign/Signal 07/01/2019 07/16/2019 D72 Fail to Have Vehicle Johnson IA Under Control Name: Koedam, Jeremy Jonas DL/ID: 769YY3726 pursuant to Iowa Code 4321.10, 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: Koedam, Jeremy Jonas DL/ID: 769YY3726 9/1/2021 C7 - Driver & Identification Services Iowa Department of Transporation ti ry O — cr.:rrI "o n rn 'v o71 w