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Home My WebLink About14-235 Authorization Number 1 Y 2 3 .5- l 1 (Office Use Only) glist )/€1/Ow C, b,amizmohi its Assinglar APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday.) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First! Middle ast 1. Name(REQUIRED) Ga642r7-KtQrT /WAos, 2. Mailing Address(REQUIRED) kV& E. Courr S% 3. Contact Information (REQUIRED) Email: 8uwr 1'1 A),e ®Grnwt J Cell PhoneC3/9) 4. Prior experience in transportation of passengersycAv Cob 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? yp Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 4)o Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When Xedi o CJ dwy -M e S. u a 1 + Keo,.l 8//9/00a , d 64,euw Okra /3 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? . 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) 1Uo DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE:CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIE RMEW . ..;, -; 4 You must apply for an individual Department of Criminal Investigation Report(form avail015iupoit-requiP (OVER FOR REQUIRED SIGNATURE AND NOTARY) — 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number' 14'7 Xy/,o/5( . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 Applicarit-MDate/O//,//y YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by G ., )'M J +-. fA ?IA-0 p q . On this 1 7 12kday of 0<-X0.11-Car �1 q 4 S1 n�P044, IA rm� WENDY S.MAYER Notary Public in and the State of low . . .ommisslon Number 729428 • My commission Expires **********ow # * 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). ,r /D/('7J ' Y Signature • a ref or designee e YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. /72 le - � / 7//77 Signatu of CityClerk or designee Da 9 9 Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2"(width)and 51/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update Clerk/fAXIDRIVBADGEAPPL92014amended.DOC 09/2014 Sep. 30. 2014 11 :40AM Div of Criminal Investigation No. 0889 P. 1 11110'd25/2014 14:39YeIIow Cab of Iowa City {FAX}31933827uC F..031/002' • ..,....0.2,......,,-. STATE L' OF IOWA ,,,1,„„x._ • ;,' fr;av rMi • Criminal History Record Check ' �` � „1 Re est r _. �,, = Request o rm 4. ,.;= • • • DCI Account Number: 9967-F___ orepplieablo) ' ' To: Iowa Division of Criminal Investigation From: Yellow Cab of Iowa City Support Operations Bureau,a4 Floor P.O.Box 428 215 E.7'h Street , Des Yrioinea,Iowa 50319 Iowa City,IA. S2244 (515)'7254066 ' (515)775-6080 Fax (319)338-9777 , • • Phone: . • • Fax: , (319)3394302 , I ant requesting an IoWa Criminal Ristory_Recor4 Check on; _ Last Npm jmande1ory) rind Name(mandetor�)'• ' Middle Name(tzcvramendod) • • • Oh4 . "a Date .ii Birth(mandatory) . Gender(mendeoo:yl Soeial•Security Number(rccommendodL • MM . /N . 19S I( . OIVlale DFemale +Ito-9'1•'1BIA, 1 p Waiver Information:Without a signed waiver from the subject of the request;a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complgtq criminal history-record Information,as allowed by law,alwayx • obtain a waiver si attire from the sub act of the r:,tient. • - Walver Release:l hereby give pcmission for the above roquesllna oaicW to mnduct an Iowa erlminal b1Aory reeotd*bock with the Division of Criminal Investigation(DCI). Any criminal history data(ancomina me that Is maintained by the DCI may be heIcased as pilOwed by kw. • Waiver Signori - ' • o a Criminal Hi: a Record C i :ek Resultstum on1)j As of 1•0 ,a search of the provided name and date of birth revealedi a r) --t rn ...- lz] No Iowa Criminal History Record found with DCI Q Iowa Criminal History Record attached,DCI Ii • DCI Initials r , , DCI-77(08125/10) • u.,.. ..,,.a Time con ')c 1A14. . 1•d1PNLNn nr) . Iowa Department Transportation 4.11140Woe or l)rw r Senates (Toll Free) 532-1121 4PO iliox 9204,U i!s Moms, to 50305•9204 515-244-9124 stViri FAX:515.239 1+33f Certified Abstract of Driving Record Inquiry Date: 10/2/2014 DL/ID#: 627XX6064(IA) Customer#: 2375713 Name: Phelps,Gilbert Allan Class: A ID Status: None Address: 1206 E COURT ST Audit#: 4423124 DL Status: VAL Issue Date: 06/10/2010 CDL Status: VAL City/State: IOWA CITY,IA Expiration Date: 05/14/2015 CDL Cert Status: Non-Excepted 522403234 Intrastate Endorsements: L CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 5/14/1958 Mailing IOWA CITY,IA Sex: M City/State: 522403234 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/19/2011 09/21/2011 M14 Fail to Obey Traffic Johnson IA Sign/Signal 02/05/2013 02/25/2013 S92 Speed (10 mph& Buena Vista IA under in 35-55 mph zone) r-.2 Name: Phelps,Gilbert Allan DL/ID: 627XX6064 C., _ —4 _ Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Departi2i4 ofMnspoptrbn, do hereby certify that I am the custodian of the records held by the Office of Driver Services,that this i ue and accuratcpy of li g 0 an official record currently in the custody of said Office, and that I have been authorized by the Dire-to the.Iowa Dtment of Transportation to so certify. C 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: ' {Qprtvh 10/2/2014 s T i+*'''''4..itt 14:: IOWA % ‘. i=xessitivy ‘17...D. . i." - - - - _ IN alk DR Office of Driver Services Iowa Department of Transporation