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Home My WebLink About15-107CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. /)— �ii (Office Use Only) 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 1. Name (REQUIRED) 2. Address (REQUIRED) 61:5 cn�-, : kk r711 3. Contact Information (REQUIRED) Email:L�'l�ptl`� tr?r, �ctW`Cs.l�`�CellPhone:�l�'�ICLQ"��3% (All written communication se via email) 4a. Chauffeur's License expiration date (REQUIRED) °9, 7 �- `1-7ED) ' i b. Taxicab Business Name (REQUIRED) _ Cal10W co -10 D 16iu36, 1 n -i q 5. Prior experience in transportation of passengers:(3�CXY" ( L, C 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? DL 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) C= DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT �2T1 DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE ERF R V� � You must apply for an individual Department of Criminal Investigation Report (form avaitSW upi .<t -- (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARBr 2 9 Co 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Dep rtment of Transportation a valid Chauffeur's license number E (1�}A -7 -7 issued on —0MA expiring on 2 2 9� s`� • 1 understand that if I falsely answer any qdesti6r& 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 prvisionnns of T4Le 5, Ch pterf the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant.) r\" F� Date — 116Z - 0 015 #**#***X*X*#****#X#XXxXX**#Xh#hX#xh*kxx*****************x*************WWWWW***XXXXX*X***X**xh*x*X*Xxxx*x*Xxxx*********************************k* STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by �-� t �� CrvS thyo41 &s on this 2 $ day of _� Wn I 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). Expiration date of Chauffeur's license o -ec�/7 Signa e of Pol' ief or esignee =ai- Date 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. Signature of City Clerk or designee Date Office Use Only ,� 0 C) "fir ci "77 Approved application DCI report C7-{ N ..., State certified driving record Website update ca m Cl.,k/TAXIDRNBADGE PPL92014..ended.DOC 0312015 ;iViay�26, 20154:17PM�eYDiv o Criminal Investigation No.8106 P, 2/2 - 06/22/2016 is:, d06b (&I CrimiSTATE OF IOWA nal History! Record Check Request Form TO: 1611/a Division of Criminal Investigatlop Support operatlons Bureau, I" fluor 215 C. 7"' Street DU Maines, Iowa 50319 (515) 725-6066 (515)'725-6000 Rax I alit 1'1541 V estill e an ]OWa Criminal T4i0 nry Barron r`t.o,.l. -- DC] ACCalml Number: _ 1",DDa — r (i r nyylicoAJc) From; Citvai'Iowa City City Clerk's Office 410 E. Wasbingtna street Iowa Cl(y, IA 52240 Phone: 319-356-5041 Fax: 319-356-5497-- Last Name (saandarory) Ent iiTame (mandalory) � Middle Dame (recomnlcndnp t ( AateoPBirthonaoaam�-)__ Gender(mandalon') As of {10 �o l ('S� a search of 1110 provided name and date of birds revealed: SocialSecurilNumber rocomded mm q fj11a1c OTelnale 0`0ver Inforin4li0l1: Wit llaut a signed WA I Vet' from the su bj ect of the request, A Complete crimiu a)) hj$j Dry record may not be releasable, per Cade of Iowa, Chapter 692.2. Rot' comnletQ criminal history record information, as allowed by IAN', always obtain a waiver sf InAture train the spb eet of the r¢ uesc Wolper Release: I hereby give pemlissidn for rhe abovo rcgbesling official m conduct as JO Wn criminal history record check aeilh rhe Division of Cnminel hU-B56990on (DCI). Any criminal hislory data muerning me rlsar is maintained by me Dcl may be released as allowed by law. C t Waiver Signature: 1 - 1OW2- Criminal History Record Check Results t ( (DCI use only) As of {10 �o l ('S� a search of 1110 provided name and date of birds revealed: l r No lotva Criminal History Record foundwith llCT t �.I r1"J Gla. ❑ Iowa 0 hninal 1--1is101y Record attached, DC1 #E5 Cri—•) ;z DQ initials Ok t VJ L - II kUOILJ/JI/) Received ilme May. 22, 2015 3:16PM No. 8767 _;. INVAViowadotgov SMUTER I SHIMPE_F I CUSTOvv, E D Rik, Office of Driver Services PO Bax 9204 Des Moines. IA 50306-92134 Phcr*e 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www Jowadot-gov Inquiry Date: 5/21/2015 Name: Crosthwaite, Luis H Address; 815 OAKCREST ST APT 7 City/State: IOWA CITY, IA 522463478 Mailing Address: 815 CAKCREST ST APT 7 Mailing City/State: IOWA CITY, IA 522463478 Convictions Certified Abstract of Driving Record DL/ID #: 609AH7197 (IA) Customer #: 5988796 Class: D ID Status: None Audit #: 8467371 DL Status: VAL Issue Date: 09/23/2014 CDL Status: None Expiration Date: 02/28/2017 COL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: Corrective Lenses Restriction None Date of Birth: 2/28/1962 Supplement: Sex: M History Information f"fano:• Gale Ccnvictiors Data ACD Explanation County 3UR 10/09/2013 11/26/2013 M14 Fall to Obey Traffic Sign/Signal Johnson IA 05/08/2014 05/28/2014 592 Speed Johnson IA 06/18/2014 07/17/2014 M14 Fall to Obey Traffic Sign/Signal Johnson IA 07/28/2014 08/28/2014 S92 Speed Johnson IA Name: Crosthwaite, Luis H UL/I@ 609AH7197 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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 1 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: '•: PIff 5/21/2015 IOWA : Q'$ • t 68111iR Office of Driver Services qy Iowa Department of Transportation Name: Crosthwaite, Luis H DL/ID: 609AH7197