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Home My WebLink About15-243r CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX IDENTIFICATION NO.�?_ (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 First 1. Name (REQUIRED) 5l MU e / 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: 4a. Chauffeur's License expiration date (REQ�UIIRR b. Taxicab Business Name (REQUIRED) _ '1r 5. Prior 9 ��+kS ns5/rte — I of passa VA, --f M :so commun 0 Ski Last /I'?eA �� fvi ), �� ✓Cell Phone: 1 sent via email) sfo1C ox1//D 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? /1 .S+cr r4.tvr�,� cm"ftk�t� When What happened to the charge? (Circle one) K-tonvicted Dismissed Deferred SuspendedPlead Gu' Other 7. Have you been arrested / charged with any traffic offenses in the last five years 5dj jl�4 0/19S74:1- g C, 114 /7 What happened to the charge? (Circle one) onvicte 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? ('C S 5hi S�Ercir r, Type of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please ") n DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CI REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 rs APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Depprtment of Transportation a v lid Chauffeur's license number 3r�r9E ly7S issued on o3fo`I/�C(� expiring on t.75fc�3�gpW _ 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 Date%j,'r/ Soli STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Sg r \ ��arh o c on this l SI^ day of - r AC( ' ., ' in and for 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 CjVj Iowa t;A(Title 5, Chapter 2, City Code). kfffeur's license ordesignee late 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. 1, 4 SS gatui of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date cierWrMJDRN6ADGE PPL92014e lded.Doc 03/2015 �4WVVADGT MM., 5MARTER d S6tr":PLER I CUSiilNA"LP UktVf N Office of Driver Services PO Bova 9204 ! Des Moines, rA 50306-3204 Phone: 615-244-9124 1.900-532-1125 Fax-5.15-239-1£37 vrvW iowadol-gov Inquiry Date: Customer #: Name: 10/1/2015 1925346 Certified Abstract of Driving Record DL/ID #: 332AE1495 (IA) CDL Permit Class: None Class: D Kenner, Samuel Joseph Audit #: 9189893 Address: 308 E BURLINGTON ST Issue Date: 06/23/2015 County APT 106 12/12/2011 02/28/2012 M14 Fail to Obey Traffic Sign/Signal Expiration 05/03/2022 10/05/2012 02/13/2013 Date: Fail to Obey Traffic Sign/Signal City/State: IOWA CITY, IA 52240 Endorsements: 3 Mailing 308 E BURLINGTON ST Restrictions: Corrective Lenses Address: APT 106 Restriction None Mailing IOWA CITY, IA 52240 Supplement: City/State: Date of 5/3/1973 Birth: Sex: M History Information Convictions CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med status: None None None None None VAL None EEG None None Citation Date Conviction Date fico Explanation County JUR 12/12/2011 02/28/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA 10/05/2012 02/13/2013 M14 Fail to Obey Traffic Sign/Signal Johnson IA 10/25/2012 12/04/2012 N04 Fail to Yield to Emergency Vehicle 'Johnson dA 01/25/2015 04/09/2015 M14 Fail to Obey Traffic Sign/Signal 'Johnson IA Sanctions Type Effective End ACD Explar ion Occurrence 3148 Ju'k Suspended 03/30/2013 .06/27/2013 W01 Habitual Violator IA IA Suspended 01/02/2014 01/22/2014 B63 Fail to Refile SR22 IA IA Suspended 09/16/2014 11/24/2014 B63 Fail to Refile SR22 IA IA Name: Kenner, Samuel Joseph OL/ID: 332AE1495 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: Sep.23. 2617 11,49AM Div of Criminal ]nvestigatlC0 R�o.6122 f. 1/9 Fro rn:.�uy m rows ..ny Cl orK �,rroa arm _5ne sal 09/21/2016 6/ rr27a ✓.uu2/002 —T STATE OF IOWA Cl`imi»lal History Record Check Request Form To: luwa Division of Criminal )nvesllgation Supporl Operations Bureau, 1'r Floor 215 r. 7''' Street 1)es Moines, lovcro 50319 (515) 725.6066 (515)925-6080 Fax an Date o R cord Check on: i•st Name pnandan DCl Accouol Number: C-( tb (if cpplicoblc) ll om: City of fowo City City Clerk's (}ffi— ce ��—�'' 410 Er Washingloa Street 101va City, TA 52240 Phone: 319-356.504f Fax: -T19-i56&549? -- Mmale ❑remale ,,ufyer AnJor%11111011: Wilhaut a signed waiver from liresubJect of the request a coo fete ethninal be releasable, per Code of Toava, Chapter 692.2. For complete crhninal history record infurrnatloll, as eiloxed by laza, ah ayst abtainaNaiver si Nature trom the snb eel of the request. R"aiver ReTBaSe:I hereby give pennissioa for the St0Vcregeea1in80ffiCW to conduct as 10111 16,11,411 hinnry record cheek with the Division ofCrim;osl Irmestiaalioa (DCJ). Any uimifid ln,tory dela M'Oeming me Thal is n by the ACI may he rdeascd as allowed by lawn waiver Sigilature: .— Yowa Criminal Histor Record Check Results MCI use only) As of a search of the provided Dante alld dale of birth revealed tJ Na Iowa Criminal Ms(ory Record found with DCI Iowa C1•iminal History Record attached, UCI f}�/J DC1 initials' r; DO -77 (08125110) Received Time Seo.91. 9015 3:51PM No.6499 Sea.23, 2015 11:49AM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00451531 NAME: KENNEN,SAMUEL JOE KENNEN,SAMUEL JOSEPH KENNON,SAMUEL JOSEPH DOB SEK RAC MGT 19730503 M W 603 DCI 00451531 PAGE 1 OF 3 DATE PRINTEO- 2015/09/23 WGT EYE HAIR SKN PDH 190 GRN BRO FAR TN ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19921218 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L43115001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WE INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L43115801 RESTITUTION SENTENCE JAIL 48H FINE $500 02 ARRESTED 19950326 AGENCY: TA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321A-3S DRIVING UNDER SUSPEND TRK#: 014624201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321A-32 DRIVING UNDER SUSPENSION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014624201 SENTENCE FINE $250 03 ARRESTED 19950406 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- O1 IA STATUTE IA321A-32 DRIVE UNDER SUSPENSION TRK#• 014626201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321A-32 DRIVING UNDER SUSPENSION CHARGE CLASS: MISDEMEANOR CONVICTION DISP EFF DAT 19930910 19930910 DISP EFF DAT 19950519 No. 6722 P. 2/9 Sep 23 2015 11:49AW, Div of Criminal lnvestigafion TRK#: 014626201 SENTENCE FINE $300 04 ARRESTED 19950524 AGENCY: IA0160000 CEDAR CO 50 CHARGE NO- of IA STATUTE IA321A-32 DRIVING WHILE LICENSE SUSPENDED TRK#: 012126701 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE; IA321A-32 DRIVING WHILE LICENSE SUSPENDED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012726701 SENTENCE PLEAD GUILTY FINE S250 05 ARRESTED 19960417 DCI 00451531. PAGE 2 OF 3 DISP EFF DAT 19950519 DISP EFF DAT 19950811 19950611 AGENCY: IA0520200 I014A CITY PD CHARGE NO- 01 IA STATUTE IA124-401(3) POSSESSION/SCHEDULE I/MARIJUANA TRK#+ 024159501 CHARGE NO- 02 IA STATUTE IA727-2 BALE OF FIREWORKS TRK#: 024159502 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3-2 POSSESSION /CONTROLLED, SUBSTANCE/SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024159501 SENTENCE DISP EFF DAT FINE $300 19960906 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA727-2 SALE OF FIREWORKS CHARGE CLASS: MISDEMEANOR CONVICTION TRO: 024159502 SENTENCE DISP EFF DAT FINE $250 19960906 K'0.6722 F, 3/9 Szp.2;. 20155 11:49AM Div of Crlminal lnveshi aiion No, 6722 DCI 00451531 PAGE 3 OF 3 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 P, 4/9