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Home My WebLink About24-004 • IDENTIFICATION NO. Zy °C)1 (Office Use Only) 1 .= 1 ®141&Ki ps Application Fee: $15.00 41P-01111 '�- APPLICATION FOR NON MOTORIZED PEDICAB DRIVERJHORSEDRAWN DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday.) 410 East WashlnGton Street )on•a City. Iona 52240-I826 (319) 356-5040 (319) 356-5497 FAX First Middle Last t 1. Name (Required) &'v & 1 Andrew l=tppolc>, 2. Address(Required) �5 4 S SE. 1 V} •3 1^4est De.5 5(( 5 3. Contact Information(Required) Email:&veil pp01& live. CrA Cell Phone: 5\5-3 2.l— 7`1 qq 4a..Driver's License expiration date (Required): 05 - 0$- 2.6 30 b. Pedicab/Horsedrawn Business Name(Required): .!- 1 CLY- t 5. Prior experience in transportation of passengers: ll-�rs• 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) r ) rl . Convicted Dismissed Deferred Deferred Suspended Plead Guilty Other 7. Have you been convicted of any traffic offenses in the last five years? /VO 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? No 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 1 must apply for an individual Department of Criminal Investigation Report(form available upon request) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) dent Non Motorized PedbcatMorse Drawn Dnve App.doc 03i2015 f 1 1" I herebycertify that I have issued to me by Is the sued o a partm 022 Transportation pispgrtoanion valid Driver'sI nde stand that if I Ate° falsely answer anyquestions in this application, that this applicatio may be denied. I agr e t 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 a license is granted, to comply at all times with all of the i provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) ' Iicant - z' ._ Date_ Signature of Applicant__ - t I GARY D. HARMS R Commission Number 840705 j • ' My Commission Expires July 12,2025 *yK,.*********M*******************************************************************'*************R*****************irxlerex..************** STATE OF IOWA ) COUNTY OF JOHNSON ) PS 7-1i Sum, ibed and swornQ/7 before me by �� +., i �. On this day of Ll� a ublic' an for the State of Iowa **********„********,t*****************************************************************************************-*************Irfririrint-ste ***** 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). Expiration date of Driver's license Jr 4---b,o 7/ZL Z Signa ure of Poli 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. -\ .._t—Lc r),. (-......L'-ico,' . Signature of City Clerk or designee _. y 1 ate ********************************************************************************************************************************************* Office Use Only Approved application DCI report V �„ State certified driving record v c`j.r Website update r ' tia derk'Pedicab Non Motonzed Horsedra,yn Dnvc APP 2015.doc ... rill 1 Iowa Division of Criminal Investigation ." Criminal History Record Check Request Form - -- DCI Account number(if applicable] REQUESTOR INFORMATION Name(business or indivkduaO Mailing address(street/PO Box,city,state,zip code) David Andrew Lippold 2545 SE 1st VUtst Des Moines, Iowa 50265 Phone number Fax number Email address (515) 321-7499 Daveliippold@ live.com I would like the results sent to me by °Mail O Fax g Email I am required to have the results notarized: l°Yes O No for specific requirements in another country only. SUBJECT OF REQUEST INFORMATION. Multiple names require a separate Request Form and fee. LAST NAME(required) FIRST NAME(required) MIDDLE NAME(recommended) Lippold David Andrew DATE OF BIRTH(required) GENDER M, F or Other(required) SOCIAL SECURITY NUMBER (recommended) 05/08/1966 M 483769465 RELEASE AUTHORIZATION INFORMATION:Without a signed release from be 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 nformation,as alowed 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. This response only includes public criminal history data.Under Iowa law.most juvenile records are confidential.Confidential juvenile court records cannot be included in this response.A signed release authorization is not sufficient to obtain this information from the DCI.In order to request the release of confidential juvenile records,if any.an application must be filed pursuant to Iowa Code 232.147(18)through the Clerk of Court Criminal history data concerning convictions for certain juvenile sex offenses can be found online through the the Iowa Sex Offender Registry(SOR).Even though some information is available online through the SOR the actual records for juveniles may still be confidential and cannot be provided.In order to request the release of confidential juvenile records if any,an application must be Hied pursuant to lows Code section 232.147(18)through the Clerk of Court. RELEASE AUTHORIZATION:I hereby give permission for the above reRuestfno 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 DC)may be released as allowed by law. I understand this can include Information concerning completed deferred judgments and arrests without dispositions.I understand the signature beiow certifies the Information provided is true and accurate.Furthermore,I understand this is an official statement and record.Any false statement(s)made In this record may result In further action. RELEASE AUTHORIZATION SIGNATURE David Lippold �, .f c,-: FOR DCI USE ONLY ,_ • ' S�` r\ do ,'O .• 't A. As of .1,)_-?..„,..1 a search of the information provided revealed: ? 4f NO IOWA CRIMINAL HISTORY RECORD FOUND WITH DCI i I t; i ‘0... '17%. s: Q t ' O AN IOWA CRIMINAL HISTORY RECORD WAS FOUND.A COPY OF THE REC 0)S iNC, p60'-DC.:'. ■ Processed by �4 sCttZ01'` WE By completing these forms online. your request will be automatically sent to DCI for processing after clicking "Submit'. STATE.OF IO'W'AiDP� PLEASE NOTE: When submitting a request online - do not submit the same request by mall, fax or email. If so, it will be treated as a new request requiring payment. JUL 1 0 2024 FennDCa-779/22121 DIV OF CRIMINAL INVEST 4IOWADOT MOTOR VEHICLE DIVISION PO Box 9204 Des Moines,IA 50306-9204 515-244-9124(ph) 515-239-183?(fax I www.lowatfot_gov Certified Abstract of Driving Record Inquiry Date: 7/18/2024 DL/ID#: 976AA8700 (IA) Customer#: 1952764 Name: Lippold, David Class: A ID Status: None Andrew Address: 2545 SE 1st St Audit#: 6372574 DL Status: VAL Issue Date: 05/27/2022 CDL Status: VAL City/State: West Des Moines, IA Expiration Date: 05/08/2030 CDL Cert Status: Non-Excepted 502658304 Interstate Endorsements: Motorcycle CDL Med Status: Certified Mailing Address: 2545 SE 1st St Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 05/08/1966 Mailing West Des Moines, IA Sex: M City/State: 502658304 CDL Medical Examiner's Certificate Certificate Specifics Explanations Medical Examiner First Name Katie Medical Examiner Last Name Swift rso cn Medical Examiner License Number A162591 Medical Examiner National Registry Number 9374686520 Medical Examiner Jurisdiction IA Medical Examiner Phone (515) 241-2020 Medical Examiner Type Advanced Practice Nurse Medical Certificate Restriction 1 Wearing corrective lenses Medical Certificate Issued Date 08/31/2023 Medical Certificate Expiration Date 08/31/2025 Date Added to CDLIS Driving Record 09/06/2023 History Information CLEAR DRIVING RECORD Name:Lippold, David Andrew DL/ID:976AA8700 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: w or ', 7/18/2024 1. -//7/(bazioLl I �;c cah Motor Vehicle Division �<<4t DDC'- Iowa Department of Transporation Name:Lippold, David Andrew DL/ID:976AA8700 Lz- CJ f� 7 David i First Name 3ti. itir Jib ,p�ii� ' Andrew �o city of� Middle Name A C" LIPPOLD Last Name D-Taxi Business Name 24-004 $ Iowa City Permit ID 07/25/2025 Permit Expiration Date David First Namer Andrew �`� City oPA Middle Name .4 cr LIPPOLD Last Name D-Taxi Business Name Att 24-004 Iowa City Permit ID 07/25/2025 Permit Expiration Date