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Home My WebLink About24-002 IDENTIFICATION NO. 2‘-k -O Q Z. 1 (Office Use Only) AMOR :owl; 1X,1 Application Fee: $15.00 me 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 410 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) ' ie.T C LA 1.1. 2. Address(REQUIRED) (!_l 09 P mot y;P �J�i C h,PY\ ed cr 2 it 3. Contact Information (REQUIRED)Email:Oa„', $u c y C.c,ivi Cell Phone:3 t 9-I-I' -1 S S 3 (All written communicakion sent via email) 4a. Driver's License expiration date(REQUIRED) 0 i/O 1-fi `a 0 b.Taxicab Business Name(REQUIRED) j 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 U 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? Ye-', Type of offense } Where When ��/►12iz�Zi .Sp c. 1 - 05/06/2cz2 Pcx nq SC kcal 13cAc 01 / t / 2cr�-�{ S pc �3 ei J 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? /11O 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) L (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 ()CJ )& Ct iLiO j issued on U 'L _ O xpiring on 0/0 1 22 2�- . I understand that if I falsely answer any question's in this application, that this applicati n 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, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant (w` �" Date I p.P Z y 2a0 ** STATE OF IOWA COUNTY OF JOHNSON ) Subscribed nd sworn to before me by I, JLZV` c�L f , �'T on this 0-4- day of ) 114, KELLIE K GRACE (� ),�� Commission Number � Z JC2p My C m issio Ex ary P blic in and for the State of Iowa *** I have reviewed this application, DCI report,and the State certified driving record of this applicant aria have Qe'termined 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 I/c1 /2r1z.._7 h. Si if4ture,11 t ' V32,2_ 1/4..olice Chi of or sig nee ate / 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. VJ1..Ci. 9-- b.st k_14- Signa re of City Clerk or'desig 1 Date ******************************************************************************************************************************************** Office Use Only Approved application DCI report / State certified driving record ✓� Website update Clerk1TAXIDRIVBADGEAPPL92018amended.DOC 04/2018 4410 IOWA DOT MOTOR VEHICLE DIVISION PO Box 9204 Des Moines,IA 50306-9204 515.244-9124(ph) 515 239-1837(fax) Www_{owadotgov Certified Abstract of Driving Record Inquiry Date: 3/27/2024 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 None CHIEN RD Supplement: Date of Birth: 01/04/1970 r ' Mailing IOWA CITY, IA Sex: M City/State: 522455614 fi -CI History Information c N 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 zone) 04/28/2022 05/06/2022 M75 Passing School Bus Johnson IA 01/18/2024 01/19/2024 F04 Seat Belt Violation 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 Apr. 1. 2024 12: 05PM DCI IOWA No. 3108 P. 1/4 03/27/2024 WED 14t21 FAX aaa DCI 0002/003 FAX r STATE OF IOWA mow:,; ,I•- /r'` � -_ Criminal History Record Cheek 0 '; ,is:, „IOWA A,", Request Form r,. 'ate oak DCI Account Number! t-Le.,v.- -F (ifapplicablo) Mail or Fax completed forms to: Send results Iowa Division of Criminal Investigation Name City of Iowa City Support Operations Bureau,1"Floor City Clerk'a Office 215 C.7r'Street Address Des Moires,Iowa 50319 Iowa City, IA 52240 (515)725-6066 (515)725-6080 Fax Phone 319.356.5041 Fax 319.356.5497 I am requesting an IowaCriminal History Record Check on: Last Name (mandatory) First Name(mandatory) Middle Name(reeotnmended) - Date of Birth(mandatory) Gender(mandatory) _ _ Social Secur'i0 Mumber(recommended) d 4 /Q LI ( ( I 1 0 E Male EJFemale 4 g L\-(,) 4' -3 6 1 0 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 complek 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 glue permission ran dto above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation(DCI). Any criminal history data conccnting me that Is maintained by the DCI may be released as allowed by law. I understand this can hieledo infnnualion concerning completed deCcncd judgmcnta and arrests without disposllions. Release Authorization Signature:l�nt.v'to ‘",/( L Iowa Criminal History Record Check Results,,,,, ,,,,5,,, (Do use only) �ptti f Z 64 As of l* I. ?-WI- ,a search of the provided name and d ,IrtF►i-tVeale)lt � u) No Iowa Criminal History Record found with DC ,� .h ve Cr/. n, -11 0 . scary r nab E o d c'4WtS r o n ❑ Iowa Criminal History Record attached,DCI# ,�•,•• 0 DC! initials_.__ mil. '•• off in a,,, to _..._. nation Sac* ,," —i ,, DCI-77(updated 06-26-2018) Page I of 2 David r First Name Diu ' 1iiiraworm'Mr —`6`Cuong fQ city of �Middle Name 4'A C‘ TIET Last Name Big Ten Taxicab Business Name 24-002 - Iowa City Permit ID Aiiiiiii O4/29/2025 Permit Expiration Date David i l .1 First Name ate, Cuong 4iD City of,�"�► Middle Name A - TIET Last Name Big Ten Taxicab Business Name 24-002 -50 Iowa City Permit ID 04/29/2025 Permit Expiration Date