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Home My WebLink About15-069IDENTIFICATION NO. 1S — O( o9 p t (Office Use Only) ��.=.®d wry" Lry APPLICATION FOR TAXICAB I 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 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) A <!z %I An 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email:n I f c Z4 q r�id,i,/xell Phone: /All written communicate n' ent via email) 4a. Chauffeur's License expiration date (REQUIRED) /0 '2 f Q o / b. Taxicab Business Name (REQUIRED) A rY t2 C 0 S 5. Prior experience in transportation of passengers: M 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? eP Type of offense Where When / What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended dead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? ZES Type of offense Where When Convicted Dismissed Deferred Suspended CP-Iead,GUty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? L^ G? Type of offense Where When r' 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) 02/2015 ON APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I herebycertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Z 2 Y J� (-- /0'.3 / 4 issued on f // ?n expiring on /o 2, FJo/% 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 the provisions of Title 5, Chapter 2, of,the City Cade. (Needs to be signed in front of a Notary Public) J Signature of Applicant ��u , -_— z. �� . Date_, z (p- � O s STATE OF IOWA ) COUNTY OF JOHNSON ) Serb cribed and sworn to before me by d<e0 vi kt9 t ` �)i , �,I on this (ri '( day of 1l <<�vS LcY A I YEMEN 3 - Expires in and f& the State of Iowa I have reviewedt]17bVIpplication, DCI report, and the State certified driving record of this applicant and have deter- mined that there is n& information which would indicate that the issuance would be detrimental to the safety, health or welfare d residends o t e y of Iowa City (Title 5, Chapter 2, City Code). Signa re of Polic. C ' or designeeDale' 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. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. IL Signaturtrof City Clerk or designee Da e Office Use Only Approved application DCI report State certified driving record Website update a.✓rAXIDRIVBADGEAPPL92014 me. d,d. DOC 0212015 Ma r. 25. 2015 12: 23PM 03/24/2015 11:22 FAX Div of Criminal Investigation No.3326 P. 1/3 + DCI IOWA LC 003 S STATE OF IOWA Criminal History Record Check Request Form Sot 16VOPlvioleuorCremlaatlaw0e11101102 Support Operations Bureau, 14 Moor Z15 if, 70 street Da M0111N, laws BW19 (!15) 7Emw (515) 7254080 Fax DCl Aecouot Nambta: Sy3 3 �M to I From: rr•a'�iws�llx! 1165}tvt-a De - "met ,( 314 338 - Fen 319 SSI 21 LaetName mwuw First Name ) MiddleN�me , Date olglrth muaete Gender oamm� social Security Number Lao Owe OFemale ��J J d' r Walver %rWormarlon: without ■ signed waiver from the subleet of the request. a complete crlulual butoryrecord mey dot be releaabW per Code of lova, Chapter 692.2, FOY 9WnIM ehmiesl hirtory record tnfermstton, u snowed Irl taw, alwsya obtain a waiverazoature from the subjed of the requaL . firalVer Reread: t haieDy sive �esirA„ Nueaecre:wwrmu ogkieimowawY mbw edndod Mrury,mord CUd xem dr DIr41ee nrLYanfW rmegaedao P4 Adrab " d hidwy dMommoles In" o fmtneuln J* NeDM (MY be MIMPOW M dlrud W Iw. Waiver Srg+tarare: �� o7w�en_ Mtory Record Check Results (DC1i9ou4r) As of bf7 + 5 a search of the provided name and date of birth revcaled; ❑ No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCf N DCI Inittals-21SIL, xi -77 (08/75110) Aar>iver� Tuna Mar 74 MI q 11-17AM Nn 1g7A Mar. 25. 2015 12:23PM Div of Criminal Investigation F IOWA CRIMINAt HISTORY DCI 00873083 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2015/03/25 DCI:00673083 NAME: POWELL,AENNETH WAYNE DOD SEN. RAC HOT WGT EYE HAIR SKN POB 19611029 M W 602 266 GRN SRO MED IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT UR ARM CCH RECORD ++* 01 ARRESTED 20090804 AGENCY: IA0700100 14USCATINE PD CHARGE NO- 02 IA STATUTE IA124.401(3)-2 POSSESSION CONTROLLED SUBSTANCE, MARIJUANA TRK#: MA003LX02 COURT DISPOSITION AGENCY: 1A070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID; 07701 SHCR041486 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: MAD03LXOI LICENSE REVOKED SENTENCE DISP EFF DAT SUSPENDED JAIL 90D 20091013 JAIL 90D 20091013 FINE $315 20091013 PROBATION 18M 20091013 02 ARRESTED 20091124 AGkNCY: IA0700100 MUSCATINE PD CHARGE NO- 01 IA STATUTE IA714.2(2) THEFT 2ND DEGREE - 1978 TRK#: MAO041H01 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(3) THEFT 3RD DEGREE - 1978 COURT CASE ID: 07701 FECR042201 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: MA0041H01 RESTITUTION SENTENCE DISP EFF DAT TIME SERVED 30D 20101104 SUSPENDED JAIL 335D 20101104 JAIL 365D 20101104 FINE $625 201013.04 PROBATION 18M 20101104 w No. 3326 P. 2/3 Mar.25. 2015 12 � 2 3 F M Div of Criminal Investigation No.3326 P. 3/3 DCI 00873063 PAGE 2 OF 2 AN ARREST WITHOUT DISPOSITION IE NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL XNVESTIOATION, 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 15 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION 4ouvvADOT 1:mMowadot.gov g>"TFR 15{E"Pt=F 1 CUSTOM--P DRIVEV...,�..-.as.. .� . _. ffte of Driver services PO BoY 9204 Des Moines. IA 50306-9204 Phone: 515-244-9124 1 600-532-1121 1 Fax: 515-239-1837 wwx.iawado[-gov Certified Abstract of Driving Record Inquiry Date: 3/11/2015 DL/ID #: 174AC6366 (IA) Customer #: 2824765 Name: Powell, Kenneth Wayne Class: D ID Status: VAL Address: 10197 77TH ST Audit #: 8913145 DL Status: VAL 07/25/2012 08/26/2012 Issue Date: 03/11/2015 CDL Status: None City/state: WAPELLO, IA Expiration 10/29/2015 CDL Cert None 10/30/2014 526539613 Date: Speed - Status: IA Endorsements: 31- CDL Med None Status: Mailing Address: 10197 77TH ST Restrictions: NONE Restriction None Date of Birth: 10/29/1961 Supplement: Mailing City/State: WAPELLO, IA Sex: M 526539613 History Information Convictions Citation Date Conviction Data RCD Explanation County 3UR 08/04/2009 10/13/2009 A33 Drug/Drug Related Conviction Muscatine IA 01/01/2010 04/29/2010 B20 Driving While Suspended, Denied, Cancelled, Revoked Scott IA 07/25/2012 08/26/2012 M70 Improper Passing Des Moines IA 08/16/2014 08/22/2014 S92 Speed - Muscatine IA 10/30/2014 11/18/2014 S92 Speed - Muscatine IA Sanctions "woe F7fective F.nd ACD Explanation Occurrence JUR JUR Revoked 12/23/2009 06/20/2010 A33 Drug/Drug Related Convlctlon IA ]A Revoked 08/19/2010 02/14/2011 B25 Driving While Suspended, Denied, Cancelled, Revoked IA IA Name: Powell, Kenneth Wayne Ill 174AC6366 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: - � W41" 4