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Home My WebLink About15-088r ��,+ter®tai -a• � �wr�,l CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa S2240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. 15--08 0 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the appfication firstMiddle I tiq PA In r .o I 3. Contact Information (REQUIRED) Email: (AA written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED), b. Taxicab Business Name (REQUIRED) 61 Prior experience in transportation of pe Last Cell Phone: 31 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 1T IU What happened to the charge? (Circle one) rj'i' 1 �-�j/t� �c- Convicted Dismissed Deferred Suspended ' lead Guilty Other NO Twy 6, Have you been arrested / charged with any traffic offenses in the last five years? What happened to the charge? (Circle one) _ Convicted Dismissed Deferred Suspended Plead Guilty Other Ppf)v F,N 8. Has your driver's license or chauffeur's license been suspended or revoked in the last Ive years? Type of offense Where 9. Have you ever applie" be an Iowa City taxi driver using a different —S/).-�-kq provide the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI)INIObRW AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATIONOIVE4HIEF REVIEW You must apply for an individual Department of Criminal Investigation Re 03 rm available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 12 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I here y rtify that, hv JJssued to me by the Iowa Dep Transportation vali Chauffeur's license number S P1 �y`i � (o issued on 3 1 expiring on 19' 1 2V , I understand that if I falsely answer any questions in thispplication, that this app icati n may be denied. I agree that in making this application, I consent to allow agents or emplpye s chf the Ci wa City Iowa, in their discretion, to examine any and all records and documents relating to this applaf a d I er agre that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisio s a er 2, of t e City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date % /r STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by . S_c.C# • _ �d�r on this ) 1 n day of APi the State of Iowa have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined 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)).. xpiration date of Chau is license D �� Signature of Police C ief or signee 1t L Pate - 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. X7,.d k' Signa re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update to CledOrAXIDRNBADGEAPPL M14amended.DOC 03/2015 CIowa Department of Transportation Office of Ofsyer'3eii 4 Toll Flee) M 5321 t21 F 0 Bet:. 92114, DG'S M0II505, IA 5D306 9204 Sl!, -244 -4124 FAA 519 2391831 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 4/14/2015 DL/ID #: 407AF8706(IA) Customer #: 1533865 Name: Dorr, Scott Edward Class: D ID Status: EXP Address: 1749 PARK RIDGE Audit #: 8940172 DL Status: VAI. DR Child Support Suspended Issue Date: 03/20/2015 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 02/18/2020 CDL Cert Status: None 522412741 Suspended 03/26/2014 09/14/2014 D51 Non -Payment of Endorsements: 3 CDL Med Status: None Mailing Address: 1749 PARK RIDGE Restrictions: Corrective Lenses Restriction None DR Supplement: Date of Birth: 2/18/1963 Mailing CORALVILLE, IA Sex: M City/state: 522412741 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 103/27/2012 105/09/2012 F04 Seat Belt Violation Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 05/25/2010 08/16/2010 D51 Non -Payment of IA IA Child Support Suspended 05/25/2011 05/27/2013 D51 Non -Payment of IA IA ---Child5upport Suspended 03/26/2014 09/14/2014 D51 Non -Payment of IA IA Child Support Name: Dorr, Scott Edward DL/ID: 407AF8706 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 15 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: 4/14/2015 `IOWA`: Office of Driver Services Iowa Department of Tra nsporation Name: Dorr, Scott Edward DL/ID: 407AF8706 KpY, i9, [U19 J;U9rwl Ulv or � r i T i n a i invesiiga[ on NO. 7Ull r, 7/17 ' +W. "+y CI BeK U"". 319 3666-B7 04/14/2016 12160 6023 p,002/002 STATE OF IOWA ( Illiillalisf,f. °,. 1y 1 Check .I\ S / lei 11I equest Form TO: Iowa Division of Criminal Investigation Support Operations Bureau, fa' Floor 215 E, Th street Des Moines, Iowa 50319 (515)725-6066 (515)929.6080 Fax Scot DCI Account Number: yC —F (a applicable) From; City oflowacil City Clerk's oftice 410 E, Washington street Iowa City, IA 52240 Phone: 319-356-SO41 Fax: 319-356.5497 E PWAm �)'/ 1 Mp 3 1 O;Male ❑Female I C`73 `tP —(9l I Waiver Inf0YMaltonf Without a signedwaiverfrom the subject of the request, aest, a complete history record may not be releasable, per Code of Iowa, Chapter 692.2. For c_omolete criminal history record information, as allowed bylaw, always obtain a waiver shmature from the suhiect of lhn Waiver Release: lh.by give permi+sion fer the elrorer esr o�"1to aol Oct ` IOwdeilnllnalh my record check wilh the Division ofCriminal lnve511gation (DCO, My criminal bisrory rise canmming o dl mab In b I I ay be released allowed by law, WaiverSiRnafure: n /I - -- - - — — -- ' ••, •" `c�- (DCI use only) As of a search of the provided name and date of birth revealed: n=> ® No Iowa Criminal History Record found with DCI m (n to rl c; In :u0 Iowa Criminal history Record attached, DCI # )> o DClinitials_AC ca err— �• r�> N DCI -77 (09/25/10) Received Time Apr. 14 2015 12:35PM ho.5342 n p r I9 [uI) �:u)rlw VIv 0T 6 r i m i n a I Inves[igai:0n N0. h0 1 F. 6/13 DCII00455730 NAME; DORR,SCOOTRK DORR,SCOTT EDWARD SCOOTER DOB SEx RAC 19630210 N N IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI 00456730 PAGE 1 OF 1 DATE PRINTED - 2025/04/15 HGT WGT EYE HAIR 5 K POE 600 185 BLU BRO MED GA ADDITIONAL IDENTIFIERS SC L WRIST CCH RECORD *�* 01 ARRESTED 19930326 AGENCY: IA0520200 IOWA CITY FD CHARGE NO- 01 IA STATUTE IA236-2A ASSAULT W/INJURY TRK#: 005989601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA236-2A PLED TO SIMPLE ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 005989601 SENTENCE DISP EFF DAT FINE $50 19930922 02 ARRESTED 19950210 AGENCYr IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J-2 owl TRK#: 014616901 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 TA STATUTE: IA321J-2 Owl CHARGE CLASS: MISDEMEANOR CONVICTION TRK# : 07.4616901 SENTENCE DISP EFF DAT JAIL 6D 19950217 PAY SURCHG FINE $500 19950217 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY 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 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIV SIGN OF CRIMINAL INVESTIGATION