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Home My WebLink About24-001 IDENTIFICATION NO. 2.L1 - o 0 l 1 (Office Use Only) Application Fee: $15.00�/Aflow); ilk 1l 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 5 2 2 40-1 826 (319) 356-5040 Last First Middle (319) 356-5497 FAX 1. Name(REQUIRED) "UU VI t 1-`'‘Yl l G W1 2. Address(REQUIRED) � �-I0C� Pi ,c-\Y°e hu C14°,,en 2o+ c 22." 1 raw C;; 4 y 3. Contact Information (REQUIRED)Email: Cell Phone: '; (All written communication sent via email) 4a. Driver's License expiration date(REQUIRED) D CIAO 1/20 2 lei b.Taxicab Business Name (REQUIRED) 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? .,1'\0 Type of offense Where When 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 When 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? 1'0 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) U (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 herebycerti t a I ave.is ue - me bythe Iowa De artment of Transportation a valid Driver's license number Z b,+ b issued on /b/2(3 V.j expiring on 0 VO /201C. I understand that if I falsely answer any questions in this application, that this applicat(on may be denied. I a(greethat 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 ilpf 2 of-2n4) ** STATE OF IOWA ) COUNTY OF JOHNSON ) It _S cribed nd sworn to before me by IA_ r W K on this `� k day of Rx jj.)___0 V -(..A.-- 4'1 KELLIE K GRACE o CCnx Commission Number 85006go:ary Public in and for the State of Iowa `, My C miss' n Expires ************irk******.*******t************************* *************************irk**************************************************ink****** *** 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 Gb /?�L(� fr 16, , I 4-/ c/gp,-2... \---/ SiPo nature of Police C of or designee ate 11 c ca 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. Signat re of City C erk or designee Dat ********************************************************************************************************************.*********************** / Office Use Only Approved application .// DCI report // State certified driving record ✓// Website update Clerk/TAXIDRIVBADGEAPPL92018amended.DOC 04/2018 1 . 1 U Viii4 DOT ..... MOTOR VEHICLE DIVISION PO 8Lx 9204 L) l>6'c i•rn,IA 50306-9204 515 244 9124(ph) 515-239-1837 iI i,: www.I4wa iotgov Certified Abstract of Driving Record Inquiry Date: 3/27/2024 DL/ID#: 433ZZ6758(IA) Customer#: 1542644 Name: Truong,Trinh Cam Class: D ID Status: None Address: 1404 PRAIRIE DU Audit#: 4282777 DL Status: VAL CHIEN RD Issue Date: 10/26/2019 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 06/01/2026 CDL Cert Status: None 522455614 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1404 PRAIRIE DU Restrictions: NONE r..a CHIEN RD Supplement: None Supplement: Date of Birth: 06/01/1970 `"(*7 Mailing IOWA CITY, IA Sex: F -;. City/State: 522455614 1 V History Information .. Convictions c.<> Citation Date Conviction Date ACD Explanation County JUR 11/10/2019 11/14/2019 M14 Fail to Obey Traffic Johnson IA Sign/Signal Name:Truong,Trinh Cam DL/ID:433ZZ6758 Pursuant to Iowa Code §321.10, I, Melissa Gillett, Director of Motor Vehicle Division, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Motor Vehicle Division,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: ,twe ur .,7.14 3/27/2024 Q' 4 s. 7, lif.e44f,X1 g#J.,,t,- \\. 0 i am, s ;.-, Motor Vehicle Division ,14 i DOI::-* Iowa Department of Transporation Apr. 1. 2024 12 : 05PM DCI IOWA No. 3108 P. 2/4 , 03/27/2024 WED 14122 FAX DCI 121003/003 F A X ;,tl r,n.. STATE OF IOWA .��'� .'', r • Criminal History Record Check i004 , Y. . . i ; Request Form , DCI Account Number: _ggt -F------- (if applicable) Mail or Na&completed forms to: Send results to: Iowa Division of Criminal Investigation Name City of Iowa City Support Operations Bureau,1"Floor City Clerk's Office 215 E.7ttt Street Address _L,_Washington St- —. Des Moines,Iowa 50319 IA g�240 (515)725-6066 Ioota Cl.t,I_(515)725-6080 Fax Phone 319-356-50411 -- Fax 19-356-5_49_7 .._ I am requesting an Iowa Criminal Ilistor Record Check on: Middle Name(recommended) __ Last Name (mandatory) First Name(n,andatnry) Date of Birth((manda ) (.an mdatory).- Social Security Number(Lecommcedcd) Gender (' 0 r a ❑Male ®Fetnale k R c,S _-- 5 C7 t`p Release Authorization: Without releasea signed f ort the co Clete subject crhe iminal historest,a complete y record information,as allowed by law,al history record not be releasable,per Code of Iowa,Chapter 692.2 always obtain a signed release from the subject of the request. ***This form DCX-77 is the onl a))roved release authorization form for this nil- ose,*** Release Authorization: I hereby give permission for the above requesting official le conduct an lows 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:_- -_ ..,_ — — 7 4 ',, � Iowa Criminal History Record Check Re , lt s'�,,,,,,,,,,,,y�a (ncr use only) • • As of 41 • 1•�vl01 , a search of the provided name art: t�df birth retrea• v y No Iowa Criminal History Record found with 1CI ;h/StO Cri/Tjj z � o nay ,'1 N y s rJ • • � esv(rs••� 7 r=i v '▪•. N P • v C] Iowa Criminal History Record attache DCI# `� • r� • fn DCI initials _ •........• DCI 77(updated 06-26 2018) Page l of 2 e., Trinh First Name 7r a "t Cam _. City of Middle Name Oj�_ TRUONG Last Name Big Ten Taxicab Business Name 4110, -:9., 24-001 Iowa City Permit ID 1 04/29/2025 Permit Expiration Date Trinh kilfi�rr- First Name Cam ,••O City oP s Middle Name .c.k. TRUONG Last Name Big Ten Taxicab Business Name .;; 24-001 Iowa City Permit ID 04/29/2025 \ --� Permit Expiration Date