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Home My WebLink About15-169CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. II Tfleg — (Office Use Only) r� APPLICATION FOR TAXICAB I MOTORIZED PEDICA4p VEHICLE DRIVER (Police Department review must be made between 8 a.m. t .m;,,?ond Friday) 1. Name (REQUIRED) 0<5 \ 2. Address (REQUIRED) c 3. Contact Information (REQUIRED) Email: (All written communication sent 4a. Chauffeur's License expiration date (REQUIRED) q —)-- J— $ b. Taxicab Business Name (REQUIRED) _ Mgl'c_,Q 5 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with - r w IALa�i:� a.�d email) Phone:3Mg-15'-9 9 7a Q felonies in this State or elsewhere? J- �wr vvnere When to i'rCA to, s'4 b,, n c z„ What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPlead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? fl O Type of offense What happened to the charge? (Circle one) 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? ] y n0 Type of offense Where When C��' //Q, 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) .1\ 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 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby gertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number - 1'I k � /E7.2 issued on -/ - IS- xpiring on I- /� - j o jS7 1 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 provis s of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicaDates-/7- )S7 - STATE S STATE OF IOWA ) COUNTYOFJOHNSON ) )S bscribed ad sworn t before me by 0 F0 L(. KJz i r _� on this day of 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 �Il��/C Signature 01 PolicerAlef or designee Zi, _2O/S 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. I 'T SGT/ S gna reof City Clerk or designee Office Use Only `/ //-,;- Date SDa e Approved application ea DCI report State e sy = certified driving record 7. Website update M N C lerWrAXI DRIVaADGFAPP L92d14amended.DOC ., " CJ7 , 03/2015 477410WADOT "kl `lk7kR 1.;'•i'"i t.. i'_ii3EVA, _r DfiivEN Inquiry Date: 8/14/2015 Name: Fountain, Don Allen Address: 2482 LAKESIDE DR UNIT 10 City/State: IOWA CITY, IA 522406736 Mailing Address: 2482 LAKESIDE DR UNIT 10 Mailing City/State: IOWA CITY, IA 522406736 Convictions office of Driver services PO Bo\ 22041 Des Ni A %3f6-9164 + hoi 515_244-91241800-'32-f t21 Fac 515-.239-1837 avt mwti 9ov Certified Abstract of Driving Record Di #: Class: Audit #: Issue Date: Expiration Date: Endorsements: Restrictions: Date of Birth: Sex: 554XX1893 (]A) D 9338382 08/14/2015 09/20/2017 3 Corrective Lenses 9/20/1964 M History Information Customer #: 4942488 ID Status: EXP DL Status: VAL Cl Status: None CDL Cert Status: None COL Med Status: None Restriction None Supplement: « - Name: Fountain, Don Allen DL/ID: 554XXI893 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] 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: ''itYl A N c: cam'+ y �: IOWA C .r..w Citation Date Conviction Date Name: Fountain, Don Allen DL/ID: 554XXI893 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] 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: ''itYl A N .Op. • dey4 '•:4'4Off 8/14//200j15 y �: IOWA ✓} Citation Date Conviction Date 2 ACD Explanation « - County ]OR 07/2_0/2008 01/26/2009 �A33 Drug/Drug Related Conviction ". 4ohnson IA 07/20/2008 01/28/2009 4A20 Operating While Intoxicated -v'` f34)nson IA 04/04/2009 _ 07/29/2009 A33 Drug/Drug Related Conviction J—Anson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation YUR 07/20/2008 A98 OWI Test Failure IA Sanctions Type Effective End ACO Explariation Occurrence 7UR 3UR Revoked 07/31/2008 01/26/2009 A60 _OWI Test Failure IA IA Barred 03/16/2009 03/15/2012 W01 Habitual Offender IA IA Revoked 03/17/2012 09/12/2012 A33 Drug/Drug Related Conviction IA IA Revoked 03/17/2012 09/12/2012 A33 Drug/Drug Related Conviction IA 1A Name: Fountain, Don Allen DL/ID: 554XXI893 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] 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: ''itYl A N .Op. • dey4 '•:4'4Off 8/14//200j15 y �: IOWA ✓} _ of Driver ces 2 oweTransportation aDepartme t of Name: Fountain, Don Allen Dill 554XXI893 oe Aub. 11.� 2V5410 51AM C Vv of 'r minal Investigation No -3205 P. 2/8 i ACI LONA 10003 STATE OF IOWA ' °s Criminal History Record Check Request Form To: Sown ))Ivl mmfCrlminalIoveetiptloo Support Operation Durran, l" Floor 2351:, 7a Sheet Dae Moloes, loan W310 (516) 715• m (5l5) 72544 Fox e ,,.,-t- DCT Acnount Number: wrt+et Fremi , VAAa ,u s lixi 114 5}avc.,s Qn 001L A saaM o Phaoe: ,(311) 33f' kmq. ales::.- 3t1 551- �9 i�at NumOJJ First Name Middlo IVatae wamosaaeA r4�ln7�lr1 %-an UC—N Date of Birth QIMAeo mdee Goender m SocialSecurityNumber �e M w*d q— a Q - 6� Zinie ❑Femrle / aSe,3 ^ % 7 " % / Cl /'l Waiver IttformCADu: Without signed waiver hone the enbjeot or the request. a cemplN0 crlmEnal lfbtory record may not be releaeabk, per Code erlovra, Chapter 69:,2. For complat Criminal butory rKord tofarluatlon, as allowed bylaw. always blula a w LlrwjNpjff# hem the NNW of the r Waiver Relearn)haetyarmreneWbnMiboebn�, ngwitgoffwWncomWmienxnimeeih6wrymord�ckWith tonhWnaerClw" „Inad ry aw may be nlaad a dimiad by 4W. rm'mupibn r�n. Any ��7' &e�uwi.+nno WrIverSknalare/ wwa trunmaii Ugrary rwcAro ncl:l .r ILn incl arse enlr) As of 1 a search of the provided name and date of birth revealed: r^ No Iowa Criminal History Record found with DCI n i Iowa Criminal History Record anoched, DCI DCL lnillais_4 r- - j u DCI -77 (0825/10)', g � N a Received Time Aug. 14. 2015 12;29PN No. 5564 LI Aua.17 2015 10�57AM Div of Criminal [nvestivation N6.3205 P. 3/8 s IOWA CRIMINAL HISTORY DCT 00299159 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 6 DATE PRINT7:D- 2015/08/17 DCIi00299159 NAME: FOUNTAIN,DON ALLEN FOUNTAIN,DONALD ALLEN DOB SEX RAC HOT WGT EYE HAIR SKN POS 19640920 M W 602 300 ELU 13W FAR TX ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC ARDON SC BACK TAT BACK TAT L ARM TAT LF ARM TAT R ARM TAT RF ARM TAT UL ARM TAT OR ARM CCH RECORD • • k .T✓; .»-^ ;� O1 ARRESTED 19820923 AGENCY: IA0160000 CEDAR CO 50 CHARGE NO- 01 IA 6TATUTE IA716-4 GRIN MISCH 2ND DEG TRR#: 523159301 ::::,a• N COURT DISPOSITION [J1 AGENCY: TA016015J CEDAR CO DIST COURT J COUNT NO- 01 IA STATUTE: CRIMINAL MISCHIEF 3RD DRORES CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23159301 SENTENCE PLEA13 GUILTY PROBATION i8M SUSPENDED YY 02 ARRESTED 19830428 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- 01 IND EXPOSURE TRK#: L23159401 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE: IA709,9 INDECENT EXPOSURE - 1978 CHARGE CLASS: MXSDEMEANOR CONVICTION TRK#: L23159401 RESTITUTION SENTENCE DISP EFF DAT COURT COSTS 19831003 PROBATION lY 19031003 SUSPENDED 365D 19831003 Aug. 11. 2015 10 MM Div of Criminal Investigation No, 3M DCI 00299159 PAGE 2 OF 6 03 ARRESTED 19060119 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- O1 IA STATUTE IA719-1 INTERF W -OFF ACTS TRK#: L23159501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 XA STATUTE: IA719-1 INTERFERENCE WITH OFFICIAL ACTS CHARGE CLASS. MISDEMEANOR CONVICTION TRKµ; L23159501 SENTENCE FINE $25 SURCHARGE COURT COSTS ¢20 04 ARRESTRD 19860920 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 TA STATUTE IA719 INTERF W -OPG ACTS TRH#: L21159601 CHARGE NO- 02 IA STATUTE JA123-46 PUB INTO% TRK#: L23159602 ul COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 1A STATUTE: IA719-L INTERFERENCE WITH OFFICIAL ACTS „- CHARGE CLASS: MISDEMEANOR CONVICTION TRH#: L23159601 SENTENCE DISP E'FF DAT PLEAD GUILTY 19070116 JAIL 2D 19870116 COURT COSTS 020 19070116 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA123-46 POB INTOX CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23159602 SENTENCE JAIL 2D COURT COSTS $20 05 ARRESTED 19801025 AGENCY: IA092000D WASHINGTON CO SO CHARGE NO- 01 IA STATUTE XA700-2-2 ASLT TRK#: L23159701 COURT DISPOSITION P 4/8 Au g. 17. 2015 10:56AM Div of Criminal Investigation DCI 00299159 PAGE 3 OF 6 AGENCY; IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2-2 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23159701 SENTENCE DISP EFF DAT SUSPENDED lY 19890209 06 ARRESTED 19911026 AGENCY: IAD160000 CEDAR CO SO CHARGE NO- O1 TA STATUTE IA708-2-1 ASSAULT CAUSING INJURY cn TRK#: L23159601 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE: IA700-2-1 ASSAULT CAUSE INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23159801 SENTENCE DISP EFF DAT JAIL 10D 1,9920527 SUSPENDED 20D 19920527 07 ARRESTED 19911106 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STATUTE IA708-2A DOMESTIC ABUSE -ASSAULT TRK#: L23159901 TO BENTON CO COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA700-2A DOMESTIC ABUSE CHAROE CLASS: MISDEMEANOR CONVICTION TRK#: L23159901 SENTENCE DISP EFF DAT JAIL IDD 19920227 08 ARRESTED 19911109 AGENCY: IA006A000 CHARGE NO- 01 CRIMINAL MISCHIEF TRK#: L23160001 COURT DISPOSITION AGENCY: IA006015J COUNT NO- 01 BENTON CO SO IA STATUTE IA716-5 BENTON CO DIST COURT IA STATUTE; IA716-1 CRIMINAL MISCH-3RD CHARGE CLASS: MISDEMEANOR CONVICTION No.3205 P. 5/8 r-� Q cn t11 Aug. 17, 2015 10,58AM Div of Criminal Investigation TRKM: L23160DOI RESTITUTION SENTENCE COURT COSTS ATT BATTERERS GROUP PROBATION 2Y SUSPENDED 120D 09 ARRESTED 19970022 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA236-2-4 DOMESTIC ASSAULT WITH INJURY TREY{: 034944101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2A(2)(B) DOMESTIC ASSAULT CAUSE INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRAY1: 034944101 SENTENCE JAIL 10D FINE $250 PROBATION lY SUSPENDED 50D BATTERER'S PROGRAM 10 ARRESTED 19990307 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSS SM I MARIJUANA TRH$: 045096901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-204-4,40" POSSESSION SCH I - MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRE#: 04$096901 SENTENCE FINE $250 COURT COSTS PAY ATTY FEES 11 ARRESTED 20040307 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708.2(1) ASSAULT W/INTENT TRK#: 101108201 CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESSION OF CONTROLLED SUBSTANCE DCI 00299159 PAGE 4 OF 6 DISP EFF DAT 19920306 19920306 19920306 Nu- '1205 °, 6/8 DISP EFF DAT 19990519 19990519 DISP EFF DAT cn 19971212 -�. r_ bi 1 9 9 71212 19971212 W' 19971212 t i r7 19971212 R1 �e DISP EFF DAT 19990519 19990519 Aug 1). 2015 10�58AM Diu of Criminal Investigation DCL 00299159 PAC$ 5 OF 6 No. 3205 F. 7/8 TRK#: 101108202 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708,2(l) ASSAULT INTENT OF INJURY - 1978 COURT CASE ID: 06521 AGCRO60044 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101108201 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED JAIL 180D 20040625 JAIL 180D 20040625 FINE $500 20040625 SUSPENDED FINE $500 20040625 PRO13ATION 1Y 20040625 COURT DISPOSITTON AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE; IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 AGCR0rB044 CHARGE CLASS: MISDEMEANOR CONVICTION c5 TRK#: 101108202 LICENSE REVOKED SENTENCE DISP %FF DAT..,• ."�,• v7 JAIL 4D 20040625 SUSPENDED FINE $250 20040625 -z7 FINE $250 20040625 12 ARRESTED 20080720 Cil AGENCY: IA0520100 CORALV'ILLE PD CHARGE NO- 01 IA STATUTE IA124.401(5)C FOSS OF A CONTROLLED SUBSTANCE -MARIJUANA -3RD OR SVESD TRK#: 1AD040NOI CHARGE NO- 02 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF TRK#: IA004ONO2 COURT DISPOSITION AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: 1A124.4W5)C POS$ OF A CONTROLLED SUBSTANCE -MARIJUANA -3RD OR SUBSO COURT CASE ID: 06521 AGC9064071 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#, lAO04ON01 LICENSE REVOKED SENTENCE DISP EFF DAT .TAIL 45D 20090128 FINE $625 20090120 COURT DISPOSITION Au g. ll. 201§ 11):§BAM Div of Criminal Investigation No. AGENCY: IA052015J COUNT NO- 02 JOHNSON CO DIST COURT IA STATUTE: IA321J,2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE 10: 06521 ADCR004071 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA004ONO2 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 2D FINE $1250 13 ARR68TED 20090404 DCT 00299159 PAGE 6 OF 6 DISP EFF DAT 20090128 20090126 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124.401(5)(C) POSE OF A CONTROLLED SUBSTANCE-MARIJUANA-31ZD OR SUBSQ TRK#T IA006IBOI COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE' TA124.401(5)C 0 PD33 OF A CDNTROLLSD Sb88TANCE-MARIJUANA-3RD OR SUB84 COURT CASE ID: 06521 AOCROS6719 CHARGE CLASS- MISDEMEANOR CONVICTION TRK#! IA006IB01 LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 60D 20090729 _ r) FINE $625 20090729 y� 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 DCS. 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. DIVISION OF CRIMINAL INVESTIGATION