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Home My WebLink About15-242e r -k �i CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX IDENTIFICATION NO. —C�2 qs�q (Office Use Only) APPLICATION FOR TAXICAB I 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 1. Name (REQUIRED) Lat 2. Address (REQUIRED) �V % Last 3. Contact Information (REQUIRED) Email: V\ x�, Cell Phone: (All written communication sent via email) ��I S G 4a. Chauffeur's License expiration date (REQUIRE[ b. Taxicab Business Name (REQUIRED) - 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? N What happened to the charge? (Circle one) rWhere /e�o�%tea C ped Dismissed Deferred CJ - 19 Suspended Plead Guilty Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty Has your driver's license or chauffeur's license been suspended or revoked in the last five Type of offense Where When —3 % Other When When -Ta c7 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) DEPARTMENT OCRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD UST 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 VE=HICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Z,�7 7 c C issued an expiring on e�—,2 /2„ understand that if I falsely answer any questions in this application, that this application may be denied. I agree that in ming 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 L r,rr1/%i �— Date ZZ 02 — / i xxxxxxxxxxx,xxxxx++xxx+xxxxx++xxxxxxxxxx++-.txxxxxxxxxxx+xxxxxxxxxxx++xxx.xxxxxnx+.+xx+>xxxxx++xxx+xx+x+++xxxxxxxxx+++xx+,+.-xxx+.xxx+xxxxx+++xxx+ STATE OF IOWA ) COUNTY OF JOHNSON Subscribed and sworn to before me by DgU,'D A. 7CX-1 f on this m2 day of �2 c 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). COIL 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. gathre of City Clerk or designee Date ++xxxxx++++:::xxxxx+xxxxx+xxx++++xxxxx+xxx+++xxxx+xxxx+::::::xxxxx+x++:::xxxxx++++:xxxxx+xxx+:::::xxxxx+++xxx,exxrxx++:xxxxx+xsx++xxxxxrxax++xxxx Office Use Only Approved application c: DCI report State certified driving record Website update ---r�:Y N CIerN1TAXIDRIVBADGEAPPL92014amendedDOC rr Cn 0312015 � ■oSvCep. 29. Now now 4 20152 1 51 PM can Div of Crir?inaI Investigation No. 7287 P. 1/4 (FA%)3193382iw uu;/002 Criminal History Record Che Request Porm Ta: Iowa Division or Criminal Investigation Support Operations Bureau, I" Floor 215 R. I" Street MI Molnes, IOwa 50319 (515)725.6066 (519)735.6080 Fax., t am renueatinm an Iowa Criminal History Record Check on! DCI Account Number: _9967-F (trappllcable) From: Yellow Cab 9f Iowa City P.O. Box 42B Iowa City, Ir.. 52244 (319) 338-9777 ' Phono: Fax: CM) 339-7302 Last Na1Aa mr;d "o ) Virst Name (mandate )• Middle Name iraomrnendw) rp Date of Birth (inmderory) Gond or mandato -Social.Seourl Number roeommnded 9 — 2- S L laMale ❑Female:�Coaz Walver Information. Without a signed waiver from the subject of the regtsost, a eomplgte grlminal ht,,,�ory record may not be releasable, per Code of Iowa, Chapter 692.2. For gonlolpto criminal history -record Information, as awed by law, always obtain a waiver signature from the subject of the request. C�l o M > t Waiver ReleaselIhereby give permlgslonfor the above requmlingolaclaltocooduelonlowetdminaihistory meord6A2}6ld,Aeolvid(F07Crlminel Inveselgauon(DCI). Any oriminalhistory dslaeoneeminame)helismalmalnedby the DM maybereleased eselloWed by lax:• -a PF i Is - C� —v e n Waiver Signature; Z-94 (DCI uao only) As of a search of the provided namr, end date cf birth revealed: r r: ❑ No Iowa Criminal History Record found with DCI , . :;' fowa Criminal History Record e.itaohed, DCI #.------ DCI initlals--Ag� N DCI.77 (08/25110) Received Time 3aP, 26. 2015 3:29PM Ago. 8919 Sep. 29. 2015 1; 51 PM Div of Criminal Investigation No. 7287 P. 2/4 DCI:00209152 NAME: TOOMER,DAVID ALAN DOE SEX RAC 19560921 M W IOWA CRIMINAL HISTORY DCI 00209152 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - 2015/09/29 HGT WGT EYE HAIR SKN POB 511 200 BRO BRO MED IA ADDITIONAL IDENTIFIERS <a SC CHIN <'3 SC R KNEE CCH RECORP '*** fes:3 01.AR9E0TED 19760203 AGENCY; IA0520000 JOHNSON CO SO CHARGE NO- 01 N DRIVE UNDER INFLUENCE/LIQUOR r'' TRK#: L10193201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: OPERATE MOTOR VEHICLE: UNDER INFLUENCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L101732ol SENTENCE DISP EFF DAT JAIL 10D 19791120 02 ARRESTED 19560716 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L10173401 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123,46 CON6UMPTION / INTOXICATION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#- L10173401 SENTENCE nISP EFF DAT JAIL 2D 19860717 03 ARRESTED 19901103 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L10173501 COURT DISPOSITION AGENCY: IA052025J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J,2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#' L10173501 SENTENCE DISP EFF DAT <a <'3 fes:3 N r'' Sep,29. 2015 1 : 5 1 P M Div of Criminal Investlgati0n DCI 00209152 PAGE 2 OF 3 JAIL 2D 19910214 FINE $500 19910214 CREDIT W/TIME SERVED 14H 19910214 04 ARRESTED 19901103 A AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321-263 LEAVR SCENE OF ACCIDENT TRK#r L10173601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321-261 LEAVE THE SCENE OF PERSONAL INJURY ACCIDENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10173601 SENTENCE DISP EFF DAT JAIL 10D 19920214 CREDIT W/TIME SERVED 14H 19920214 05 ARRESTED 19921001 AGENCY! IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STA'T'UTE IA321J-2 OWI/2ND OFFENSE TRK#: L10173701 COURT DISPOSITION AGENCY! IA09201W WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: OWI/2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10173701 SENTENCE DISP EFF DAT JAIL 30D 19930129 FINE $750 19930129 06 ARRESTED 19931126 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 TA STATUTE IA3210-21 DRIVING WHILE REVOKED TRK#: 006508001 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-21 DRIVING WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 006508001 SENTENCE DISP EFF DAT JAIL 2D 19940304 No. 7287 P. 3/4 r -a LO ""? cn O .. r 1 Sep. 29. 2015 1: 51 PM FINE Div of Criminal Investigation DCI 00209152 PAGE 3 OF 3 $250 19940304 AN ARREST WITHOUT DISPOSITION I5 NOT AN INDICATION OF QUILT. 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, Q.IVISION OF CRIMINAL INVESTIGATION No. 7287 P. 4/4 DOT V 3t4'fr llli,�4 I �' I .3 L.L;".I LL9 �.�€6.MEF,, i,SiIA,`4 �'kU i:'V,AI.iYY i�iV [3, 0.J 4i Office of Driver services F0 Soy* 97-04 s Des [-Moines„ iA 503OF-9204 Phone. 515-2.44-3124 1800-532-11121 1 Fat: 51235-1537 wwvJ. lowadat-gov Certified Abstract of Driving Record Inquiry Date: 10/2/2015 DL/ID #: 127AC6033 (IA) CDL Permit Class: None 10/2/2015 Customer #: 1934738 Class: D CDL Permit Issue None Date: ht11j®��R Name: Toomer, David Alan Audit #: 9285470 CDL Permit Expiration None Date: `1a Address: 2742 500TH ST SW Issue Date: 07/28/2015 CDL Permit None Name: Toomer, David Alan DL/ID: 127AC6033 Endorsements: FV .., Expiration Date: 09/21/2023 CDL Permit None i_` 1 Restrictions: City/State: KALONA, IA 522479214 Endorsements: 3 ID Status: EXP Mailing 2742 500TH ST SW Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing KALONA, IA 522479214 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 9/21/1956 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions otation Date ConvicEon Date ACD E>;Irlar:at:on catunt", 3t➢^ 11/17/2013 12/09/2013 N82 Improper Backing Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Data Casa Plumber JUR 07/23/2011 641185. IA 11/17/2013 767955 IA 06/10/2015 863060 IA Name: Toomer, David Alan DL/ID: 127AC6033 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: p�`i�Fly ®pF9161f 10/2/2015 ' gr IOWA a'o CD ht11j®��R Office of Driver services epartment IowaDepartme D `1a -'U Name: Toomer, David Alan DL/ID: 127AC6033 FV .., i_` 1