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Home My WebLink About15-082s r � ,Qt �III1rJtp�� CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. )S -C �o- (Office Use On_ly) APPLICATION FOR TAXICAB 1 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 application L ede "/ 3. Contact Information (REQUIRED) Email `�a� 10KIvt 8 Cf&CellPhone :3jq-g00-;-q7y (All written commugication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) _� 5. Prior experience in transportation of passengers: _ I Igo�8 �hrAr:k- '3 to S es 'I f C 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? q es Where Gc t 10- 8 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspende Plead Guil Other Have you been arrested / charged with any traffic offenses in the last five years? *0 f �5 Type o� Where When 16 What happened to the charge? (Circle one) Convicte Dismissed eferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 220 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) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2D15 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby ce ify that have issued to me by the Iowa Dep rtm nt of Transportation �qv� �id �C(�i auffeur's license number � 176 issued on l / " expiring on ,/, o „f �— I understand that if I falsely answer any questions in this application, that this aplilication 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 applicatin, and I further agre at, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions o le 5, ZCha72,oh ity Code. (Needs to be sign 715 front of a Notary Public) Signature ofApplica t J Date STATE OF IOWA ) COUNTY OF JOHNSON ) Splbscribe and sworn to before me by �L1.OAJ i �� on this / ` day of H -Dv �2-0 15 n�At y ELLIE K.TUTTLE l a ,` . Q: ',Coinr:i-F-n Humber 221819 c. °) Yong i'-7"" Nlptary Public in and for the State of Iowa Y' I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that r there is no information which would indicate that the issuance would be detrimental to the safety, health or welfaraiofi�e�Si2015 dents of the City of Iowa City (Title 5, Chapter 2, City Code). '" Me - -V'3 c;t„ 1,- 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. 41 kJ - Sign re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date dery MDRmec,o FLszmaamended.DOG 03/2015 L:Z10WAD0T ,WJ.W.d.. . Sj�iA%TF s 1 SHMIL+ri I (U)Ti}M4 uFtNFN Office of Driver Services PO Box 9204 € Des Moines, IA 50306-3204 Phone: E15-244.9124 1800-532-1121 ( Fax 515-239-1837 www_iowadot.gov Certified Abstract of Driving Record Inquiry Date: 4/8/2015 DL/ID #: 707A38376 (IA) Name: Smith, Gary Lee Class: D Address: 956 BOSTON WAY APT 2 Audit #: 7984891 Restriction None Issue Date: 04/16/2014 City/State: CORALVILLE, IA 522413170 Expiration Date: 10/19/2018 Endorsements: 3 Mailing Address: 956 BOSTON WAY APT 2 Restrictions: NONE Date of Birth: 10/19/1958 Mailing City/State: CORALVILLE, IA 522413170 Sex: M History Information Operating While Intoxicated Test Refusal/Test Failure Violations Customer #: 747183 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Occurrence ACD Explanation Jug 05/16/2010 Al2 DWI Test Refusal QA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case lNumber JUR 03/31/2015 .852459. IA Sanctions Type Effective End ACD Explanation occurrence JUR JUR Revoked .05/27/2030 05/26/2011 Al2 -OWI Test Refusal IA IA Name: Smith, Gary Lee DL/ID: 707A38376 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 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: `,: •""••Y,f�p'4�r1 4/8/2015 IOWA • %-w D. }� D. 0. T. f '••••'' or+ Office of Driver Services Iowa Department of Transportation Name: Smith, Gary Lee DL/ID: 707AJ8376 Aor• 6. 2015 9:55AM Div of Criminal Investigation No. 4612 P. 2/4 04/03/,2015 09:10Yellow Cab of Iowa City (FAX)319338270a P.002/002 r "n'sSTATE • • ��: 0.v„HistoryRecord Check itdifR, f ly: Request 1 rm Tor Town nlvulon ofcrimllml investllintion Support Operations Bureau, It' Floor 215 E. 7'a Street Des fili Iowa 50319 (515)725.6066 (SIS)'725-6080 FBI I am raoueatino nn inwn Crlminnl b ---d nL--r. __- DCI Account Number: 9967-F (urel lioablo) From! Yellow Cab it Iowa City P.O. Box 428 Iowa City, IA. 52244 (3X9)338-9777 Phone: "" it n 7010 Fax., (319) 339-7302 Last Nome mondnt First Name mondalo ' I Middle Nlarae reoommended) --3)ate,o ' filh inaddna Gender inenAem -- ' `� - Social6eotiri Nutliber re ornmended m /r7 %q .. �A4ale OFemaleQ�17'' ci Waiver Information. Without a signed walver from the subject of tha request, A complete orlminal history record may not; be releasable, per Coda of Iowa, Chapter 692,2, For complet orlminal hfstoryrecord Information, o[ allowed by law, always obtain a walver sl nature from he subject or the ra uesr, • r Waiver Release: I hereby give pemlldsFort far the above re uectingolllclal r nduel own crime bluoryrecord cheek with the Divhlon of Crlmfnst Inverllgalion (OCP, Any criminal hlrlary data 0e1111041 me main Ina yl DC lny be rel d M allowed by law. Waiver Signature'. wav 7 +wuwA u a 11G A�c3LAI 3 (Doi uleonly) As of a search of the provided name and date of birth revealed: U) ❑ No Iowa Criminal History Record found with DCI�' m ci w v o Iowa Criminal History Record attached, Del p DCI initials�_ � DCI -77 (08/25110) Received Time Aor. 1. 70111 9:111AM No.4417 Apr. 6. 2615 9:55AM Div of CrlrninaI Inv e s t i g a t i 0 n ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19980815 AGENCY: IA0560000 LOUISA CO 50 IOWA CRIMINAL HISTORY DCI 00558.123 PUBLIC INTOX MISDEMEANOR TRK#: 038959802 CONVICTION$ ONLY PAGE 1 OF 2 AGENCY: IA058015J LOUISA CO DIST COURT DATE PRINTED - CONSUMPTION -PUBLIC INTOX CHARGE CLASS: MISDEMEANOR CONVICTION 2015/04/06 DCI:00558123 SENTENCE DISP EFF DAT FINE AND COSTS NAME: SMITH,GARY LEE 02 ARRESTED 20100517 AGENCY: IA0290000 DES MOINES CO SO ' DOB SEX RAC HGT WGT EYE HAIR SKN POB 19581019 M W 508 230 BLU SDY FAR IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19980815 AGENCY: IA0560000 LOUISA CO 50 CHARGE NO- 02 IA STATUTE IA123-46 PUBLIC INTOX TRK#: 038959802 COURT DISPOSITION AGENCY: IA058015J LOUISA CO DIST COURT COUNT NO- 02 IA STATUTE: IA123-46 CONSUMPTION -PUBLIC INTOX CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 038959802 SENTENCE DISP EFF DAT FINE AND COSTS PAY SURCHG 19980930 02 ARRESTED 20100517 AGENCY: IA0290000 DES MOINES CO SO ' CHARGE NO- 02 IA STATUTE IA123.46(2)-A CONSUMPTION OF ALCOHOL IN A PUBLIC PLACE 2 COUNTS TRK#: DA002VW02 CHARGE NO- 03 IA STATUTE IA719.1(A)-1 CONSPIRACY - 0001 TRK#: DA002VW03 COURT DISPOSITION AGENCY: IA029015J DES MOINES CO DIST COURT COUNT NO- 01 IA STATUTE: IA123,46 CONSUMPTION / INTOXICATION - 1978 COURT CASE ID: 08291 SMSM031717 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: DA002VW02 SENTENCE DISP EFF DAT FINE $65 20110316 COURT DISPOSITION AGENCY: IA029015J DES MOINES CO DIST COURT COUNT NO- 02 IA STATUTE: IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS COURT CASE ID: 00291 S14SM031717 CHARGE CLASS. MISDEMEANOR CONVICTION TRK#: DA002VW03 SENTENCE DISP EFF DAT FINE $250 20110316 No. 4612 P, 3/4 Apr, 6, 2015 9:55AM Dlv of Criminal Investl,ahoo No,4612 P. 4/4 DCS 00558123 PAGE 2 OF 2 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 NDN -LAN ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION PURNISHEA. WE CANNOT CONFIRM OR OENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION `