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Home My WebLink About15-168IDENTIFICATION NO. 11 1 (Office Use Only) �+��r -t4 APPLICATION FOR TAXICAB / 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 ra191 356-5040 Q 19) 356-5497 FAX First Middle Last 1. Name(REQUIRED) lVjOW(g5 CCr-t- +J -,A 2. Address (REQUIRED) Cf PIC% i, bI6t-' I 3. Contact Information (REQUIRED) Email Cell Phone: '31f1 11171 (4J - (All written communication sent via email) 4a. Chauffeurs License expiration date (REQUIRED) %/ (3/1 b. Taxicab Business Name (REQUIRED) ffi5V jU tql 1, 5. Prior experience in transportation of passengers: UY;�:�2 r� b 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? r 3 Type of offense Where When C, P./y bicW H))✓tw co..rrrq UI'l dyI �lJ ilr.jr-0:1 h✓P�(uY�f bi4ol� yar l fc�✓1f( �j� What happened to the charge? (Circle one) Convicte 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 (5 00" i/�'I -h-i o17c� trr(v",.� S �P1 30h45oi ?�1� What happened to the charge? (Circle one) onvicted 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?� Type of offense Where C 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please 31u 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 certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number -7!2N7i5ti issued on 5/t'lo I( expiring on 7i13rl 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 Code. (Needs to be signed in front of a Notary Public) Signature of Applicant p rvwl{ Date STATE OF IOWA COUNTY OF JOHNSON AU scribed and sworn to before me by fV lC-6litS inti &e / on this day of KELLIE K. ')tate of Iowa 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 C uffe is license 3 2ol /ylr� Signa u e ,r P lic designee IDate 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. �,��77,,cc''��,�-uta � , \ ig8 natare of City Clerk or designee Me N O 7:2 W.I C3_ Office Use Only 1_)_< ={e� a s.. Approved application tTr E DCI report a' State certified driving record o Website update s CleAd7AXIDRIVBADGEAPPL92014amended.DOC 0312015 �1 DGT 5h ttFTEx 4 E ii i%; 1 CUSTOME: (R Vic% sd111�'%'1J,iC4'�iidradotigov - Office of Driver Services PO Box 9204 ; Des Moines, FA 507306-9204 Phone_ 535-244-9124 1800.53'2-1121 i Fax 515-239-1837 www.iowado!.9ov Inquiry Date: 8/19/2015 Name: Trimbell, Nicholas Scott Address: 636 S DODGE ST APT 6 City/State: IOWA CIN, IA 522404836 Mailing Address: 636 5 DODGE ST APT 6 Mailing City/State: IOWA CITY, IA 522404836 Convictions Certified Abstract of Driving Record DL/ID #: 700YY9754 (IA) Class: D Audit #: 5200022 Issue Date: 05/04/2011 Expiration Date: 07/13/2016 Endorsements: 3 Restrictions: NONE Date of Birth: 7/13/1978 Sex: M History Information Customer #: 377160 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Pail to Obey Traffic Sign/Signal Citation Date Conviction Date ACD Explanation County )UR 05/09/2003 '.01/05/2004 A20 .Operating While Intoxicated 'Black Hawk '.IA 10/26/2012 ,12/11/2012 M14 Pail to Obey Traffic Sign/Signal .Johnson IA 02/27/2015 .03/23/2015 M14 Fad to Obey Traffic Sign/Signal Johnson IA Name: Trimbell, Nicholas Scott DL/ID: 700YY9754 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: ............. r#.4, 8/19/2015 IOWA :-*i D. 0. T. -*i .. BBI11tt� Office of Driver Services Iowa Department of Transportation Name: Trimbell, Nicholas Scott DL/ID: 700YY9754 Nu g. 1I. 201§ II 33HIUI Dlv of Ur I M I n a I InVeSTIVaTlon F.orn:4lly of Iowa Cl'y Clc.k Ofeloe 319 366aaeY W0.Zf27 Y b/II 06/10/2016 OM:os 41F3 P.002/002 STATE OF 10WA Crelninal ffistory t.et;n�A ChocEt Rech e.o Form O To: Iowa Division 01 Criminal lnvesyigation Support 0136rstions ldurran, 1" Floor 2151;, 70' Street Des Moines, Iowa 50319 (SIS) 725-6066 (515)725-60on Fax \4Y. 1 am requesting an Iowa Criminal 1- FI M kjp"l / Record I)Cl Accouiv Number: �6 0�L 1� roia: Ci[y of lorve Cif City Clerll's Orrice 410 1Washlnyfml yiree! _�_^ -____ IOWA City-, )A 527.40 Ph on c: 319-356-SO41 Fax: 319-356-5497 Male ❑p+ernole VI�3' 13'�S�II rrfffver wJorn:rrfrors; Withouta signed walver from thesubject of the request, a emnplele m�lminal hlslory record may mol be releasable, per Code of Iowa, Chapler 692.2. Fm complete criminal history record information, as allowed by law, always obtain a waiver sinnahrrr frnn, el— a..l.:...r-rvv,.. ------- Waiver Release: I Ileraby give perxlissian for IAC ObDVC requesting o(faiel to condo[ a Iowa criminal n5ko !ecoid e D tY heck wllL diC Division ofCriminel Investiealion ( CII. My crimLsal hisloq� dale concemin, me Ihal ism ainleined bylM1e DCI may he released as allowed by law, 1'1'4[Ver Sly piature: lowa Criminal History Record Check results As of 8 - — /� — a search of the provided name and dale of bir111 .-_ � 11 No Iowa Criminal History Record found with DC:1 loWn Criminal Hisiury Record aliaehed, ll( -`I N DCI111111aISDC1-77 (09125110) Received Tlrrle Aug. 10. 2014 HOW Nlo.4944 tDCI use only) :.A rl _ f:a - r N Cr" Aug.11 1014 11'33AM Div of G(imioaI Inveetigatioo IOWA CRIMINAL HISTORY DCI 00620515 FELONY CONVICTION PAGE 1 OF 3 DATE PRINTED- 2015/OS/11 DCI:00620515 NAME: TRIMBELL,NICHOLAS SCOTT DOB SEX RAC HGT WGT EYE HAIR SKN POB 19750713 M W 509 170 SRO BRO FAR IA ADDITIONAL IDENTIFIERS TAT BACK TAT R LEG TAT UL ARM CCH RECORD *** 01 ARRESTED 20000512 AGENCY: IA0070100 CEDAR FALLS PD CHARGE NO- 01 IA STATUTE IA123-47(1) PROVIDING ALCOHOL TO MINOR TRK#: 600115601 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE: IA123-41-1 PROVIDING ALCOHOL TO MINORS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 600115601 SENTENCE FINE $250 PROBATION 1Y SUSPENDED 60D 02 ARRESTED 20020723 AGENCY? IA0070100 CEDAR FALLS PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSE MARIJUANA TRK#: 600841401 CHARGE NO- 02 SA STATUTE IA714-2-4 THEFT 4TH TRK#: 600841402 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE: IA124,414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 01071 SRCR107637 CHARGE CLASS: MISDEt4EANOR CONVICTION TRK#: 600841401 RESTITUTION SENTENCE FINE $50 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 02 IA STATUTE: IA714.2(4) THEFT 4TH DEGREE - 1978 DISP EFF DAT 20000912 20000912 20000912 DISP EFF DAT 20021018 11b�LILi �. N/II Aug.I1. 2U1� II'J�PM 0 i v of Criminal InvesIigaIion 1V0.2129 r. Iui COURT CASE ID: 01071 SRCR107637 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 600041402 RESTITUTION SENTENCE SUSPENDED JAIL 30D FINE $250 PROBATION 2Y 03 ARRESTED 20030509 AGENCY: IA0070000 CHARGE NO- 01 OWI IST OFFENSE TRK#: 601141201 COURT DISPOSITION AGENCY: IA007015J COUNT NO- 01 BLACK HAWK CO 50 IA STATUTE IA321J-2 BLACK HAWK CO DIST COURT IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 01071 OWCR114032 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 601141201 DRUNK DRIVING SCHOOL LICENSE REVOKED SUBSTANCE ABUSE EVALUATION RESTITUTION SENTENCE TIME SERVED 5D SUSPENDED JAIL 115D JAIL 120D FINE $1000 PROBATION 2Y DCI 00620515 PAGE 2 OF 3 DISP EFF DAT 20021016 20021016 20021010 DISP EFF DAT 20040106 20040106 20040106 20040106 20040106 04 ARRESTED 20040724 AGENCY: IA0070100 CEDAR FALLS PD CHARGE NO- 01 IA STATUTE IA124.401(5)(M) POSSESSION OF MARIJUANA TRK#: 601629101 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(3)-2 P0009SSION CONTROLLED SUBSTANCE, MARIJUANA COURT CASE ID: 01071 SRCR124512 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 601629101 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT Aug, IL 2U1� II'."J,AIVI U I v oT l.Y m i nal Invc.3TigaIIon uQz. z� r, II/II COMMUNITY CORRECTIONS SUSPENDED JAIL FINE PROBATION IMPOSED REVOKED TIME SERVED COURT DISPOSITION AGENCY: IA007015J COUNT NO— 01 60D $250 2Y 60D BLACK HAWK CO DIST COURT IA STATUTE: IA714.2(5) THEFT 5TH DEGREE — 1978 COURT CASE ID: 01071 SMCR124519 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 601629102 SENTENCE FINE $50 OS ARRESTED 20060621 AGENCY: IA0070200 CHARGE NO— 01 BURGLARY 3RD DEGREE TRK#: 602417201 COURT DISPOSITION AGENCY: IA007015J COUNT NO— 01 WATERLOO PD IA STATUTE IA713.6(A) BLACK HAWK CO DIST COURT IA STATUTE: IA713.6A(1) UCI 00620515 PAGE 3 OF 3 20050110 20050110 20050110 20050110 20061207 20061207 20070529 DISP EFF DAT 20050110 BURGLARY 3RD DEGREE COURT CASE ID- 01071 PEC9140391 CHARGE CLASS: FELONY CONVICTION TRK#: 602417201 RESTITUTION SENTENCE DISP EFF DAT COMMUNITY CORRECTIONS 20061113 FINE $750 20061113 SUSPENDED FINE $750 2006].113 SUSPENDED PRISON SY 20061113 PROBATION BY 20061113 PRISON 5Y 20061113 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. DIVISION OF CRIMINAL INVESTIGATION