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Home My WebLink About22-007 r IDENTIFICATION NO. a-- D1 7 l (Office Use Only) --_I III ••■ inil Mg lair APPLICATION FOR NON MOTORIZED PEDICAB DRIVER/HORSEDRAWN DRIVER CITY OF IOWA CITY ,(Ptpliq Departmtyt review must be made 410 East Washington Street LULL betWeen 8 e.`m`to'3p.m., Monday-Friday.) Iowa City, Iowa 52240-1826 ' (319) 356-5040 IOWAC I T Y IOWA ' (319) 356-5497 FAX Fijst1 Middle Last 1. Name (Required) �1r►dr� QO .,t_ 5 2. Address(Required) (bib S C,o►e bl St Aft- 401 1.pwA C,+'{4, =A 522�O 3. Contact Information (Required) Email: AS9C1GeD4Pl?Vt..tolh,Cell Phone: -11Z•3(A-3 �3 Q 4a..Driver's License expiration date (Required): 1Z/2'(uIZbZ3 � "" b. Pedicab/Horsedrawn Business Name(Required): �� rp.»r 5. Prior experience in transportation of passengers: C AM81 S 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? nO Type of offense Where When What happened to the charge?(Circle one) Convicted Dismissed Deferred Deferred Suspended Plead Guilty Other 7. Have you been convicted of any traffic offenses in the last five years? I'tO Type of offense Where When What happened to the charge?(Circle one) Convicted Dismissed Deferred Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? AO Type of offense Where When 9. Have you ever applied to be an Iowa City pedicab/horsedrawn driver using a different name? If yes, please provide the name(s) 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) clerk/Non Motorized Pedicab/Horse Drawn Drive App.doc 03/2015 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 549 A G 541 I issued on q fit/ZDZD expiring on !Z/Z'' ZoZZ I understand that if I falsely answer any questions in this application, that this application may be denied. I agree that iri 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 a license is grariteti,#ts t ornpIy'at all tlirrmes with all of the pro- visions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary public)' ' • Signature of Applican trv1 Date S/!'5/Z022 antintar sLaidix ****************************************************************************************************A AAA AA A A k*****************A AA A AA AA********** STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by c\eN.2.—LA,i A-Q r/ . On this 1 23 - day of M Zd"2 7 i7 ,,0u4 ASHLEY A JAY-PLATZ Commission No.785030 Notary Public in State to iow� Mr GLnunlsaluir Expires July 14,2023 ************************************************************************************************************************************************ I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City(Title 5, Chapter 2,City Code). S 2 7/2 o Z L. Signa r o Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A PEDICAB/HORSEDRAWN VEHICLE IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. THE EFFECTIVE DATE WILL MATCH THE DRIVER'S LICENSE EXPIRATION IF LESS THAN A YEAR. Signature of City Clerk or designee Date *************************************************************************************************************** *************** Office Use Only Approved application DCI report State certified driving record Website update clerk/Pedicab Non Motorized Horsedrawn Driver APP 2015.doc q. k a k i /,e g d s tR1 6% %PIER1C S OME . R1#E ' ' ' � ' � P p pdelPttl 'm al Services a�i� t �f*,1 � - Certified Abstract of Driving Record Inquiry Date: 5/13/2022 DL/ID#: 544AG5478 (IA) Customer#: 5867853 Name: RSnyder,Andrew Class: B ID Status: EXP obert Address: 303 S KIEL ST Audit#: 4973213 DL Status: VAL Issue Date: 09/18/2020 CDL Status: VAL City/State: HOLSTEIN,IA Expiration Date: 12/24/2023 CDL Cert Status: Non-Excepted 510255066 Intrastate Endorsements: Passenger , CDL Med Status: None Mailing Address: 630 S Capitol Street Restrictions: Corrective Lenses, Restriction None Automatic Supplement: Transmission, No Manual Transmission Equipped CMV,CDL Intrastate Only, No Class A Passenger Vehicle Apt 408 Date of Birth: 12/24/1999 Mailing Iowa City,IA 52240 Sex: M City/State: History Information CLEAR DRIVING RECORD Name: Snyder,Andrew Robert DL/ID: 544AG5478 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: S 7',q r CIF , � 5/13/2022 i /9 (&) 2 i- ee L DCIONw Iowa Department of Transporation .;! •• Eftime: Snyder,Andrew Robert 111L/IF..n 544AG5478 Na" • nu IY 27 PH 1: 47 ULL-1% CIT Y, IOWA, • iirr. , 41/Allb. STATE OF IOWA ,� ►i►,,,,��,. O'' '°\ Criminal History Record Check �w .+I Request Form tl 27 P ��T4,;., ��v y DCI Account Numle:1 ‘I" be „` ' 1.-N t,-f`- �! 1 t web Mail or Fax completed forms to: Send results to:Iowa Division of Criminal Investigation Name 6ea Sl^,"p( I Pedc ( Pctve�' Support Operations Bureau,1"Floor r� ( n (� 215 E.7"'Street Address o2U0, E ` h A/�J e Des Moines,Iowa 50319 (515)725-6066 Let/ Le id 1 A- Sa`/03 (515)725-6080 Fax Phone (31a, 350—1/.29 Fax I am requesting an Iowa Criminal History Record Check on: Last Name(mandatory) First Name(mandatory) Middle Name(recommended) Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) (2—C2 11 jqqg ViMale ❑Female li Y.2- Q c1-J o102(-2 Release Authorization:Without a signed release from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2. For complete criminal history record information,as allowed by law, always obtain a signed release from the subject of the request. ***This form(DCI-77)is the only approved release authorization form for this purpose.*** Release Authorization: I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation(DCI). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. I understand this can include information concerning completed deferred judgments and arrests without dispositions. Release Authorization Signature. Iowa Criminal History Record Check Results use only) aAs of " / ,a search of the provided name and date of birth revealed: 0 y 40 1> m O+ No Iowa Criminal History Record found with DCI K i —n r- N D ❑ Iowa Criminal History Record attached,DCI# < iv p (( m to DCI initials C t ._- „ ,n�uiuiiiii, Cl) 1r DCI-77(updated 06-26-2018) o �,lowa criminal p e 1 oft :history results • „O••• e ►nu►nnnlmoo