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Home My WebLink About14-269Authorization Number 1y — a ( p ` l 1 (Office Use Only) V) `{A MOM% � CITY OF IOWA CITY APPLICATION FOR TAXI I MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) 410 East Washington Street Iowa Cit Iowa 52240- 1826 Failure to complete the "required" information will result in denial of the application (3l9) 356-5040 (3 19) 356-5497 FAX F id le Last - 1. Name(REQUIKED) Q✓ /4�s.� 2. Mailing Address (REQUIRED) eo 60(� i Z r Tu 3. Contact Information (REQUIRED) Email: Cell Phone: 3 / `% -S/,Z 92� 4. Prior experience in transportation of passengers: li - 5 71zr 5 i ki lv . �e ✓ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Ps Type of offense Where-, en 9Nn /� 7 yc uLCe s3d06d MVXMP" %✓/%� 5 d d�LBOFvx", l✓CG1/B - / �/ � "'Pe7� 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?_ -.lam - Type of /Offense Where When a ca 1 1 owe cl-Il-, / F9,5 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? P 6 Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prAvide the name(s) i DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE--QERTI14D DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE QKEF RFYIEW + , i Y Y You must apply for an individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 7,7 09/2014 I hereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number [� s i c I understand that if I falsely answer any questions in this application, that this application may be denied. I understand ''that if I falsely answer any of the questions in this application, that this application will 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 a license 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) 1 1 Signature of Applican(/ e Date Z2 YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed eind sworn to before me by Ma r`< f�, PA___ On this 1 day of in I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare cf residents of the City of Iowa City (Title 5, Chapter 2, City Cade). Signature of cChief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Sign tUre of City Clerk or desVn6ee Dat Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 %11 (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update C1e k)TM1DR!VBADGEAFP192014amended DOC 0912014 OC410WADOT SMART - WWW.CliNaCIO.C�OU ER l �{PAPLtR I CUSTOMER DRIVE^ Inquiry Date: 12/12/2014 Name: Meier, Mark Allan Address: 1031 290TH ST City/State: ATALISSA, IA JUR 527209641 Mailing Address: PO BOX 132 Mailing City/State: ATALISSA, IA _ _ 730061 527200132 Convictions 816583 Office of Driver Services PO Box 9204' Des Moines, IA 50306-9204 Phone: 515-244-9124 1 HO -532.1121 I F3x: 515-239-1937 wwwer.iawadoLgov Certified Abstract of Driving Record DL/ID #: 075AA0689 (IA) Class: D Audit #: 8410628 Issue Date: 09/03/2014 Expiration 09/18/2020 Date: Endorsements: 3 Restrictions: NONE Date of Birth: 9/18/1954 Sex: M History Information Customer #: 1683236 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: Citation Date Conviction Date ACD Explanation County JUR 10/07/2012 11/05/2012 S92 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/18/2009 500760 IA 03/12/2013 _ _ 730061 IA 09/13/2014 816583 IA Name: Meier, Mark Allan DL/ID: 075AA0689 Pursuant to Iowa Code §321.10, I, Kim Snook, Director cf 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 cooy 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 �dQetin L;-. t Ankeny) Iowa this date: _ .6� s¢ 10 WA * ;�-� 12/12/2014 • D'c. 2. 2014 11:58AM Mddle Name oeconlm6 &d) 1"/l,-/-'�-? Div of Criminal Investl,gatlon 5318 1P. VV• 1. LV1l II JJ�.I.. Y14, V,,1n 111, ". ♦.9. V14J iU Ll/3 p`�p acrn�n eYC ��1keRr,SP7%` STATE 0910W.A crrinninal History Recgd Check Re9 uegi Form 'I'o: Town Division of Criminal Iuvestlgation Support operations Bureau, Pr Finn 215 F. 7°j Street DPS Maines, Iowa 50319 (515)725-6066 C51S) 725-6000 Fart DCT AccountNuntber: L -Cot22— pr appl lcahlo) From: City of Iowa city _ City Cierh'a Office 410 E. Washington SfYeet Iowa City, IA 52240 Phone: 319-356-5041 rax: 319-356-5491 JL auL kuucauLL ¢LL iv ra �..,.,... �. ......... Iraltt Name (mandslor) ............ �....,_. ..._. Flrilt Name omdatory) )/'�/GP/ Mddle Name oeconlm6 &d) 1"/l,-/-'�-? kw�(e Date of Birth(maodalury) GP11der(nldnfilq Socinl8ecurityNTlmller rcconrmu,dcd G — S �1VTale OFemale G p G % r� ! lP Waiver rtiformation; Without a signed waiver from tilt) subject of the request, a complete criminal history recur d may net be releasable, per Code of Iowa, Chapter 692.2, For complete criminal history record Infol-matton, as allowed by law, always Wain a WAiversi nature fYam the suh ect of the re nest. waiver,Rele!(se: 1 herehygivo rtanissim forlhe A06 rcqucsling oaicial m conduct an IowyAaA crri�mhlei hlsloryrtcoed check wish mo blvlsfon orC!lnilnal 1ombisaUon (DCO. Any criminal hielocy dale eoaeemin me that Is molnmined y Iho DC1 My b" ed aa�owed by law. ' ,1 / WaiVeYSib°Pd[tlllYE: O�//� "" 9 e fid" W UUU Y` 1 Iowa Criminal History Record Ch kResults 7-: M�l„s oh,» M of i a search of the provided name and date of birth x'evealed: No Iota Criminal History Record found with ACI Iowa Criminal History Record attached, DCI # 9� o Received Tine70c- I.W014 11:33AM No. 5218 .D,, r. 2. 2014 IkHAM Dlv of Crininal Iovestkation PCI 00169110 PAGE 2 OF 2 No. -)318 P. 3/3 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE TA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 022560.101 SENTENCE DTSP EFF DAT JAIL 7D 19960221 FINE $750 19960221 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THH 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. DIV1'SION OF /MAC-RIMINAL INVESTIGATION !- c- " ;tt