HomeMy WebLinkAbout15-040410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
2. Addross(R'[P)UHWO)
11)[M I 1IT"ATION IqO..I� �_"2'
(Office Uso Only)
APPLICATION rOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 P.m., Monday — Friday)
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3. Contact Infort nation (I 6,(. J I � fl,i�) Email:
(All written cornrmllhiCatiOd Sent
4a. Chauffeur's License expiration date (RkQH1W_1))J . . ....
0" Cell Phone:
b. I axicab Business Name (W C;7tAW 4j) l" AC)S.
-, . ...... ...... ... . ......
5. Prior experience intransportation ofl)asseiigei,s:
6. Have YOU ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? JIO
Typeoffense
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have YOU been arrested / charged with any traffic offenses in the last five years?
!Kpef �offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1,A0
Typeofoffense
Where
When
9, I -lave YOU ever applied to be an Iowa City taxi driver Using a different name? If yes, please provide the name(s)
DEPARTMENT Or CRIMINAL INVESTIGATION (l)CI) REPORT AND STATE CERTIFIED
DRIVING FZECORD MUST ACCOMPANY THIS APPLICATION rOR POLICE CHIEF REVIEW
YOU MUS1 apply for an individual Department of Criminal Investigation Report (form available upon IWItIOSt).
(SECOND PAGE FOR REQUIRED SIGNATUREAND NOTARY)
02/2015
APIDLICXHON FOR TAXICE=1{' VEMICLE. 0RIVEFZ
Page 2
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid ChauffoUl's license number
.... w_ ......... ... issued on t l expiring on _ 1, Jt> .. f I understand that if I
falsely answer any questions in this application, that this application 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 thepro sions
of Title 6, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant_.._ jM .,Il.�c� Date
STATE OF IOWA )
COUNTY OF JOHNSON )
to before me by«a.,,rtt=a .._..._,
Subscribed and sworn �� � ... C w
on this fA I+Pf� day of
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).
SignatrfreofP ce- hiefordesignee
Date
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A T AXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
THE EFFECTIVE:. DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR.
Sige of City Clerk or designee
Office Use Only
<2 __z6_j_
Date
Approved application
DCI report
____........---
State certified driving record
Website update
GerWCAM DRIVBADG EAPPL92014aded. ooc 02/2015
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by ._ _ WWW,If3vvad0 q0V
SMARTER I SIMPLO I CUSTOMER DRIVEN
Office of Driver Services
PO Box 9204 1 Des M rues, [R 50306-9204
Phone: 515-244-9124 1800-532-1121 I Fax: 515-239-1537
wvAv-iuwadot.gov
Certified Abstract of Driving Record
Inquiry Date:
2/26/2015
DL/ID #:
302BB2858(IA)
Name:
Calloway, James
Class:
B
Restriction
Michael
Supplement:
Address:
2110 N DUBUQUE ST
Audit #:
4986660
Issue Date:
02/03/2011
City/State:
IOWA CITY, IA
Expiration
01/20/2016
522451624
Date:
Endorsements:
NONE
Mailing Address:
2110 N DUBUQUE ST
Restrictions:
NONE
Date of Birth:
1/20/1968
Mailing City/State: IOWA CITY, IA
Sex:
M
522451624
CDL Downgrades
Customer #: 1808601
ID Status: None
DL Status: VAL
CDL Status: ELG
CDL Cert
None
Status:
CDL Med
None
Status:
Restriction
None
Supplement:
Type Effective End ACD Issuing JUR
Downgrade :04/30/2014 j IA
History Information
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
08/08/20131754691 ---- -- (IA
Name: Calloway, James Michael DL/ID: 302BB2858
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do
hereby certifythatI am the custodian of the records held by the Office of Driver 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:
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SOS • ;/Zy++ 2/26/2015
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h�S�S Office of Driver Services
e RRIYEA
02 /:PA. 23. 2015, 1;51 PM
D
Div of Criminal Investigation
STATE OF IO
Criritioal History Its
Request For
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DCI inidats
DCI -77 (080110)
Received Time Fe b. 20. 2015 1110AM No, 1392