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HomeMy WebLinkAbout23-001 IDENTIFICATION NO. 2S-0©I 1 (Office Use Only) �t � III „T. Application Fee: $15.00 miguigar 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 4 I 0 East Washington Street Failure to complete the "required"information will result in denial of the application Iowa City, Iowa 52240-1826 (319) 356-5040 Last First Middle (319) 356-5497 FAX 1. Name(REQUIRED) C(t-o n 2. Address(REQUIRED) ` L.( OLA P ,i y , _‘); C(-A i P rl IZrl l�awM P-A`iy -1-14 ( 2 ZI 3. Contact Information (REQUIRED)Email: 1)PSN.0 ct :ell-- So l^ '1c' (.�C v r✓I Cell Phone:,)7 11-W 3-1-3 S 3 (All .written communication sent via email) 4a. Driver's License expiration date(REQUIRED) i_/ /2 02. b.Taxicab Business Name(REQUIRED) 6 .�- 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? /VO Type of offense Where When — f{ 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? / CS Type of offense Where When pcA•SS ,n S c140 a C3t.tS C o 1/6 LV1 1 e o5/o 6/254 2 r -:S0l411S6 06/1 '7/2o2I 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? Ai 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) (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 certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 69 )f ct t-j.C I issued on i 0/2. , ci xpiring on 0 r p ifed f l-. I understand that if I falsely answer any questions in this application,that this applicati n may be denied. I a ree at 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 L f— 2 5.--20 z 7 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by Qti�" 'CO-* on this 2� day of c ASHLEY A JAY-PLATZ 9 Commission No.785030 Notary Public i an r t e State of ion* My Commission Expires July 14,20Z3 *********** *** I have reviewed this application, DCI report, and the State certified driving record of this applicant arrd;flave cfe'fermined that there is no information which would indicate that the issuance would be detrimental to the safety, health or woffare of re - dents of the City of Iowa City(Title 5, Chapter 2, City Code). cr Expiration date of Driver's license � / Zv 2-7 Sig ature of Police Chief o designee D e 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. qA,Lft Signature of City Clerk orsignee EDat ******************************************************************************************************************************************** Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92018amended.DOC 04/2018 r ' 2.. /..,,,,,E,- , ::-.r ,;-: f 1 ,:*', T ) k 1, , , ,, MOTOR VIH}CLE DIVISION PO 1Jc 9204 De:,Moinc`�s,IA _=O3O5-EJ2J4 515 244-9124(ph) 515-23 1837 (fax) 4,,A,ALio'4{weldf?t.(,q' v Certified Abstract of Driving Record Inquiry Date: 3/17/2023 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 Issue Date: 10/26/2019 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/04/2027 CDL Cert Status: None 522455614 Endorsements: Chauffeur 3, CDL Med Status: None, Motorcycle Mailing Address: 1404 PRAIRIE DU Restrictions: NONE Restriction Not CHIEN RD Supplement: :-. :u `1 Date of Birth: 01/04/1970 ---. , Mailing IOWA CITY, IA Sex: M ---,; -) CO j City/State: 522455614 1 � Fri r..-• ice; History Information :z) _, iji Convictions `,•' Citation Date Conviction Date ACD Explanation County JUR 02/12/2014 02/24/2014 M14 Fail to Obey Traffic Johnson IA Sign/Signal 02/14/2014 02/24/2014 N82 Improper Backing Johnson IA 03/08/2014 06/12/2014 M14 Fail to Obey Traffic Johnson IA Sign/Signal 06/14/2021 06/17/2021 S92 Speed (10 mph & Johnson IA under in 35-55 mph I zone) 04/28/2022 05/06/2022 M75 Passing School Bus Johnson IA 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, Melissa Gillett, Director of Motor Vehicle Division, Iowa Department of Transportation, do Mar. 22. 2023 12: 05PM - DCI IOWA No. 5390 P. 4 a .,- 03/loi.Uzi wrru 10: 4z FAX -•-- ui.i iy,1003/003 ..:J� /,_.\ . u'"Vff STATE OF IOWA Li ti"\\ f $5�..,0 b ,, i� .' Criminal History Record Check d7� �t {' .r ry•IUYfA 4. ;' s.''( '' S' .1,g <fVOire Request Form .. ,,;, , ,-,.z •G vier.,.i. rd...lute. DCI Account Number: ynn "k (if applicable) Mail of Fax completed forms to: Send results to: Iowa Division of Criminal Investigation Nome City of Iowa City o _- Support Operations Bureau, tat Floor City Clerk's 0"f. tee `'`' 215 E. 7'1'Street Address 410 E, W }ington. St Ic Des Moines,Iowa 50319 "' (515)725-6066 Iowa City, lf#-52240 n x".•a., (515)725-6080 Fax Phone 319-356-5041 , .2:-7 a Fax 319^3. 4,97 .::�. ` 7 W_ I am requesting an Iowa Criminal History Record Check on: • _ o �,,. ](.Mist Name (mandatory) First Name(m6ndatory) Middle Name(racornncnded) dry Date of Birth imandatery) �^^N�^^ Gender(in6ttdato,y) Social Security Ntlmber,(tcoern,ncna ) - 211,0ii.L.,,,, q / g 14Male ❑l:ema lei 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_Rurpose.*"°~r` Release Authorization: I hereby!live permission for the above requesting official to cottducr an Iowa criminal history record check with the Division of Criminal Investigation(DCI). Any criminal history data concerning me(hat is maintained by(he DCI may be released as allowed by law. I understand this can include information concerning completed deferred judgments and arrests without dispositions. sr Release Authorization Signature:j2e,&1, � o Iowa Criminal Yristory Record Check Results ^ (DCluseon�. gt�tnumtiturtiiii4 co As of 3.qa•9- „ -�, I,A a search ofrhe prpvided..:: '�',�. �••(3uievealed: g gi z s. �, ,, " o • • . `= d 1A �• f- th . CD Z No Iowa Criminall d History Record fouviih O ^., - ® *-+_ �. • ..1. ' • -2 = I.) ( cj _ ilk_ 0 Iowa Criminal History Record attached I r ��Gl�`'r' 'q r •. • DCI ini[ia is _• ,�iti� `-'e U „• \, 1:,..) /, I o 11 ICI-77(updated 06-26-2018) Page 1 of 2 David r iFirst Name :; Cuon �`�` g ♦7 CftyofA Middle Name IN V TIET Last Name Big Ten Taxicab Business Name 23-001 — lowa City Permit ID 04/26/2024 Permit Expiration Date David P. iu First Name Cuong �`�` ♦d Cfty of A Middle Name IN C\ TIET Last Name Big Ten Taxicab Business Name 23-001 Iowa City Permit ID 04/26/2024 Permit Expiration Date