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Home My WebLink About14-2629 � 1 WIN CITY OF IOWA CITY 410 East Washington Street Iowa City, lova 52240-1826 (319) 356-5040 (319) 356-5497 FAX Authorization Number 1 q f (Office Use Only) APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday -- Friday.) Fellrere to c lgte Ifae "sem saa fresh" lenfornt�tiarre wri9! result in denial taf ffre �sd®cafioca Middle 1. Name (REQUIRED) ° c r2Yr.. 'lbw; c. 2. Mailing Address (REQUIRED)+` C °:f— l €s d qq 152 a 3. Contact Information (REQUIRED) Email z cv+i. �r�cgu"� �.dvlcw r� < e do Y Cell Phone: as imp SG f 4. Prior experience in transportation of passengers: %A,.&20' c� rc f tea• a � �r I `••, 5. 6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense N Where MM When 8. Has your driver's license or chauffeur's license been suspen ed '6r%vo64 in the last five years? r 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 6eme(s) 0 r IT -1 V� DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEPREVIEW ..„„„. You must apply for an Individual Department of Criminal Investigation Report (form available upon-rpque4 �l (OVER FOR REQUIRED SIGNATURE AND NOTARY) , U , I herebycertify that I have issued to me by the Iowa Departmant of Transportation a valid Chauffeur's license number 3 q >4 C I t) 3 I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if 1 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 Applicant :_ -""" -" ""' Date L 2 - I 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 tcgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by pw'. tw On this a"° - - _ day of 6V 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). Signatu hief or designee it Data 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. ') k. SignaftbLrof City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %1' (width) and 5'/z" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update ClmWrAXIDRIVBADGEAPPL92019amentled.DOC 09%2014 r� O 1114 D T y� RT �° q y�p�{,p gpp p q v�y,y$ p�,.�yp y S"Ji8&k$IRTE la .]tiwT38' W.§� 4 R n.USTOMEl: DWAI ..Y a w��utivea � ✓auu� o1fic'.e of wives s'ie0 se1r.';ss U'O ifral,. '9204 „003 ...3, A ,".'ra1I7PE;..r,,r2T4 Farr 515-239 1937 WWW-koircidot.a;4anw Certified Abstract of Driving Record Inquiry Dates 11/25/2014 DL/ID #g 139AC1873 (IA) Customer : 3383405 Names Gran, Scott Robert Class: D ID Status None Address 590 FOSTER RD APT B2 Audit #: 7506756 DL Status; VAL :L4 1.:1.(1,9/201,4 Issue Dated 11/07/2013 Cole Status: None City/states IOWA CrrY, IA Expiration 11/24/2018 CDL Cart None 522451527 Dates Status Endorseanentse 3 CD4. Pled None Status: Mailing Addresse 590 FOSTER RD APT B2 Restrictions: Corrective Lenses Restriction None Date of Birth® 11/24/1955 Supplement Mailing City/State: IOWA CITY, IIA Sex: N 522451527 FrTNITM =71 Date _ .�. ...._ Conviction Date ._......__ _ .. _.__.. .. ACD M—plaraitlon ,.d ...._.._.�_. County Iain 1D 04l09(20T0 S9.._..._. 2 _ _.. ..__ Spee .. _. _. _ ...__ _.... ... ohnson :7 _..,__.� 'I6k 13 01/08/20:1:4 N14 Fail to Obey Traffic Slgn/Signal......... Johnson IA :L4 1.:1.(1,9/201,4 '.N1.4 Tail to Obey Traffic Sign/Signa! =7ohnson 'IA Accidents ... Acildent involvement ilndueated does INOT mean the iindiiviiduuall was at fault or given B citation.. ,xuccid,:':int 0; to INanmo: Grau, Scott Robert IDR./IDN 1,39AC1873 Au,'l1A°'e RlWR".""er EM Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department^'of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this Is a'trlre end `accurate copy of an official record currently in the custody of said office, and that I have been authorized by the Director of`khe Iogd.,Departrnent of Transportation to so certify."` In witness whereof, I have caused my signature and the seal of the Department to be set upon this documOnt,`at Ankeny'f-Iowa this date: _ „/Nov. 13, 2014+; 4;29PMcaa Div of Criminal Investigation (FAXJ31933n27N0.4018 P. 1L2®002 4STATE OV IOWACriminal History Record Check Request Form To„ Iowa dldwdAl■o oW' rdmlmAl 1onVooftnUonn &TIPoet Op■,pmalome 11mroAddm•1B' Floor 213 1 7`o3liroe¢ DIS r1ohi n, Iowa 30319 (516) 1254066 (918),725,4030 Foo DC1A°aeountMmmbern,,,,„ 9967-17 Qdrmoved*Ahte1 Proms • Yollo cola of'or�a l t1, �m; 4511 , Iowa Mt. 44 (3191339.9777 1'hono� Faxd (F9 3339430 7a of lrth n a 4 onadarY o Seat 190 l Number( q o , Vµ ••• Maio W09WOFJIVO Ma 0110Are * 'Rhona n nggm■o wolver lram the gmbpec o3 she raq"MP4 tltl eawmlpf"a Mr—imn@mod Matou•,7 r000ra zpoP not be relmanalb%per Code mtlovuA, Chapter 6912..Poir,.1,0R0o1R1 orlmlmmll &ndmdmryraooral duatormaflon, as Mloaved by.pmvr, always allverAffleasea I hoday AIM PIUMIsston 6Orado u0ebe eoqua0 Ae Maw to monamotl Aa lova mdMb4 9lmoWreawd mhick wk, oh® nWhlem ■tcgm'row de d�ndmAQ .ter 1A�A1896Pye■na■Oln mr�mnlBBtl edAVadmmdhr�adm tl.AmmpYmeredm��mamRRmvru669'@yRAnw alf,per Skhdnnw r& 0 No Towe, Criminal History Raeord found with ■ '. 1 Iowa Cdxnhbal History,Rword zt od„ DCII „ ' g0/ DCI Initiala,.......... DCI -77 (005/10) Received Time Nov. 10. 2014 9R46AM No, 4866 Nov, 13. 2014 4:29PM Div of Criminal Investigation No. 4018 P. 2/2 IOWA. CRIMINAL HISTORY DC1 00261899 MKODZNRANOR CONVICTIONS ONLY PAGE 1 OF I TE PRINTED - 2014/11/13 DCIvOO261899 NAME a GgAU'SOOTT ROBERT DOB SEX RAC HOT WGT EYE HAXR 3XN POB 19551124 M W 601 168 BLD RED MED IA ADDITIONAL IDENTIFIERS Sc RACK AGENCY: IA0770300 DES MOINES PD RDE - 01 IA STATUTE IA321-251 Owux TRK#: L17524201 OOT9RT DISPOSITION AGENCY: IA077015,7 POLK CO DIST COURT COUNT - 01 IA STATUTE IA321-201 ONVOI CHARGE C S% MISDEMEANOR CONVICTION K#: L175242DI DRUNK DRIVING SCHOOL SENTENCE DISP EPF OAT PLEAD GUILTY 19800418 PROBATION 1Y 19500418 DEFERRED SENTENCE 1Y 19500418 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF DUXLT. THIS RECORD INTAINED EY THE IOWA DIVISION OF CRIMINAL INVESTIGATION. BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD VERS THE SUBJECT OF YOUR INQUIRY - DIVISION OF CRIMINAL INVESTIGATION