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Home My WebLink About15-183CITY OF IOWA CITY 410 East Washington Strecl Iowa City, Iowa 52240-1826 (3191356-5040 (3191356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. %moi — 2223 (Office Use Only) APPLICATION FOR TAXICAB / 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 3. Contact Information (REQUIRED) Email: 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) Last Cell Phone: (All written commbhcation sent via email) 5 Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?�5 Where What happened to the charge? (Circle one) When 2 t 6 Zoe Convicted Dismissed Deferred Suspended Plea l�Gu�ty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? (( fLS T vpe of offense Where When 171 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plea ther 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 '^sued to me by the Iowa Department,of Transportation -a valid Chaffeur's license number issued on r,� 3 /N expiring on / 3 - i S� I understand that if I falsely ai mv er 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 o-f7T/title 5, Chapter 2, of the City Code. (Needs to be signed in front tt-of a Notary Public) Signature of Applicant jz, ItA�Ll Date C /J STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworg_to before me by Anj n n p r� 1 y ��8��-Q on this day of � -77 1 �N, "` , wENov s MAYER Nota Public in an>d" o t ie State of Iowa �I commission Notary y oM fission Expires D'AA —7 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 ./ty5 (ALyJ 6 a V01000— &Z08/5 Signature ice Chief or designee 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. �2� -1� . 7 Signature of City Clerk or designee Dat kkxkwk***x*********xxxxx***xxx*x*xxxx**xxxx**x**kxxxx%xxxxkxxxkkxk%xxxxxxxxxxxxxxx*hkkx*xkkxkxxxxx%xkxxxxkkx%xxxxkkxkxkx*kkkx*:e#k**%+*k*kkkk***� Office Use Only Approved application DCI report State certified driving record Website update clerUTAXIDRIVeADGEAPPL92014amended,DOC 03/2015 AUC,27. ZU15 9:j9Awl P i v of Criminal lnvest;g5,f on No. 6294 P. 9111 Fr -m: IY 01 10w&. Coo GI6rk Ofllao ale a6es497 06/24 /2015 11:49 6226 F-002/002 STATIT or( IOWA 6�ritx�ra� .f MS01-51 11il Check Reytfes( Folin To: Iowa UieiAkm of C.rinlioel tnvestige filo, "nPPOrt Qper9Pioln hureau, 1" ll 2iS L.• 7th5^tre,et Das tomes, lolva 50319 (315) '125-6066 (515)726-6080 Pas Date WrTUM fName PCI Accnwa Humber: _u bU; _F - (i(epplicebic} Gran:lowagov City Cjcrhl$ t%ffic, - _..,.- 910 E. �Ja•hin laa Street linea City; IA 52240 Pllune: 319-356-5041 Pax: 319.3565497 C71Vlale 11FemaleR/, /, _( Y U f WatPw':llfDrfajig ll00: Without a slil waiver from Ihesubjeet of the request, a complete crimlom history record may not be releasable, per Code of town, Chapter 692,2. For com lete criminal history record obtain aweiver sl velure from the subject of the request. information, as allowed by law, always N'aiverllelenre:lhe�etygilepcnnlssionfo/lheebovc c Ipvesligand' (DC]). My aimival Ilisloq dale wnecmillp�p7e plffi s --In Official to lc DC1l ml Ipwe a,,5cd a Allm,,•nco.d Check with the Division of Cdnlinal /F•-- inlained by 1pcUCi mey he lEleascd as nllowcd b)•latt. Il/ail ler Slgnrltnre: __ff_&A� Y xvv,'a t—runlnai HIsior l Record 0N.At 11�pesutES----- As of--,--. -2a— a search of the provided narne and date of birth rcwealedf El ul No Iowa Criminal Hjstory Record found with XI - c: lipIpwa Criminal History Record attached, 1)Cj NUUzLiip l s:. D..,,.:,..A T I m „ n,,. 9e anlC li,enere el- 9090 iI Aug27. 2U1 9:39AM Div 0T UI'ITIIaI 1nVeStIgatIon No, 6294 P. 10/11 IOWA CRIMINAL HISTORY DCI 00802469 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2015/06/25 DCI:00602465 NAME: HOUSE,ANTONIO MAURICE DOB SEX RAC NOT WGT EYE HAIR SKN POE 19790703 M B 601 185 BRO BLK BLK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L SHLD TAT R SHLD CCH RECORD *** 01 ARRESTED 20070514 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA709.3A(4) ASSAULT CN PEACE OFFICERS & OTHERS TRK#: 1ADOIG801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA706.3A(4) ASSAULT ON PEACE OFFICERS & OTHERS COURT CASE ID: 06521 SRCRO79511 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: SA0019801 SENTENCE DISP EFF DAT TIME SERVED 91) 20070015 JAIL 9D 20070815 FINE $315 20070815 02 ARRESTED 20070625 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA32IJ. 2(A) OPER VER WH INT (OWI) / IST OFF TRK#t 1A001QS01 COURT DISPOSITION AGENCY: IA0520151T JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 06521 ONCR079908 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A001QS01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 2D 20071017 EINE $1250 20071017 03 ARRESTED 20081023 AGENCY: IA0520100 CORALVILLE PD CHARGE NO. 01 IA STATUTE IA708,2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY TRK#- 1A005PI01 Aug.2h, 2 0 1 h 9;39AM Div of Criminal Investigation No. 6294 P. 11/11 COURT DISPOSITION AGENCY! IA052015J COUNT NO. 01 JOHNSON CO DIST COURT IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: 06521 SRCRO84690 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#. lAO05FICI SENTENCE TIME SERVED 4D JAIL 4D 04 ARRESTED 20090525 DCI 00802469 PAGE 2 OF 2 DISP EPP DAT 20090102 20090102 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA706.2A(3)(A) DOMESTIC ABUSE ASSAULT - 2ND OFFSNSE TRK#: lAO06WVDI COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA723.4(2) DISORDERLY CONDUCT - LOUD AND RAUCOUS NOISE COURT CASE ID: 06521 SXCR087194 CHARGE CLASSr MISDEMEANOR CONVICTION TRK#: IA006WVol SENTENCE DISP EFF DAT FINE $100 20090925 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 N014 -LAW ENPORCEMENT 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 TBE SUBJECT OF YOUR INQUIRY DIVISION OF CRIMINAL INVESTIGATION IVUDDT WWW,lowadot.gov SMARt[k f 5€EAfL^ER ! CUS]'O'AEa DRIfJS`t Office of Driver Services PO Bax 9204 I Oes Moines, IA 50306-92114 Phone: 515-244-91241804-532-11211Fax: 515-239-1837 www.iowadot-gov Certified Abstract of Driving Record Inquiry Date: 8/15/2015 DL/ID #: 255DD4770 (IA) Customer #: 4342223 Name: House, Antonio Maurice Class: A ID Status: None Address: 953 BOSTON WAY APT Audit #: 8690119 DL Status: VAL 09/11/2012 4 Issue Date: 12/13/2014 COL Status: VAL City/State: CORALVILLE, IA Expiration 07/03/2018 CDL Cert Non -Excepted 08/18/2014 522411246 Date: '.Improper Registration Status: Interstate Endorsements: NONE CDL Med Certified Status: Mailing Address: 953 BOSTON WAY APT Restrictions: Commercial Learner Restriction CDL Instruction Permit 4 Permit, Corrective Supplement: Expires 4/17/2015 Lenses Date of Birth: 7/3/1979 Mailing City/State: CORALVILLE, IA Sex: M 522411246 CDL Medical Examiner's Certificate Certificate Specifics Medical Examiner First Name Medical Examiner Last Name Medical Examiner Suffix _ Medical Examiner License Number Medical Examiner National Registry Number Medical Examiner Jurisdiction _ Medical Examiner Phone Explanations Tracie Neustel-Abbott ARNP A091593 6826553121 IA (319) 356-3335 Medical Examiner Type Advanced Practice Nurse Medical Certificate Restriction 1 Wearing corrective lenses Medical Certificate Issued Date 01/14/2015 Medical Certificate Expiration Date 12/22/2016 Date Added to CDL1S Driving Record 01/16/2015 History Information Convictions Citation Date Conviction Date ACO Explanation County JUR 06/25/2007 10/17/2007 A20 Operating While Intoxicated Johnson IA 05/25/2009 06/21/2009 S92 Speed Scott IA 09/11/2012 10/10/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA 01/18/2014 02/06/2014 S92 Speed Black Hawk IA 08/18/2014 09/28/2014 '.Improper Registration Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations