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Home My WebLink About15-237l ,;ak Will CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (3 19t) 356-5497 FAX IDENTIFICATION NO._ „ 15- o2 3 (Office Use Viny 4h z// E,7 APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) LO11m—e to campAeLs ffte2regufred" infUe_mation ewit resuf€ in ca`enial of the a�ppficat.='an M 1. Name (REQUIRED) 2. Address (REQUIRED) 3, Contact Information (REQUIRED) Email: 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of ps ever been`arrested / charged with any Phone_ 3i9- -01h13 and/or felonies in this State or elsewhere? Vt& What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended <Plead Guil Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? v wll 1z z p Convicte) Dismissed Deferred uspended Plead G ilty 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Where When 9. Hav� you ever applied to bean Iowa City taxi driver using a different name? If yes, please prQa�thq,�ame( 1IAA11 n —!'C•: DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE ERTiii DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE GRIEF REUJEW 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 Iereb ce k Yat I have issued to me by the Iowa Dep trn nt of Transportationp v id Chauffeur's license number , % issued on xpinrig on U 4 I understand that if I false y &s Wer any questions in this application, that this ap ica on may be denied. II grcfe that in 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 oofffTi/ttlle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant�� DateA/�J;L/�r_ STATE OF IOWA ) COUNTY OF JOHNSON ) S ribe and pworn to before me by O'sT'�r sm KELLIE i.a`...• 5'iyrcrpni ,VYe- ✓) JD r r0 cc7 Public in and for the State on this �3 day of 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 C de). Expiration date of Chauffeur's license 03 z Z �22t� Signature of Pdllice 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. fir. _)�. Sign of City Clerk or designee Dat ci�rdlAXIDRmsAoceaPPL92oi4amended.Doc 03(2015 Office Use Only Approved application r ! rl -' DCI report ^� e.,., State certified driving record Website update <r1l -u iii ci�rdlAXIDRmsAoceaPPL92oi4amended.Doc 03(2015 } ' DOT Nw iowadot gov SMARTER I Sity't'LER t CUSTOMEF ORNE'd office of Dfivef Services PC Box 9239 1 Des EvlomiEa_ IA E0306-9204 Phone_ 515-299-9129 180f3 -t32-11,21 I Fax515-235-1837 wwwto,vadOt.t}OV Inquiry Date: 9/18/2015 Customer #: 3617557 Name: Morrow, Bret Allen Address: 916 207H AVENUE PL APT 2 City/State: CORALVILLE, IA 522411423 Mailing Address: 916 20TH AVENUE PL AN 2 Mailing CORALVILLE, IA 522411423 City/State: 04/04/2015 Date of Birth: 4/3/1964 Sex: M Convictions Certified Abstract of Driving Record DL/ID #: 075AA1630(IA) Class: A Audit 9: 8983567 Issue Date: 04/04/2015 Expiration Date: 04/03/2D20 Endorsements: NPT Restrictions: Corrective Lenses, CDL Intrastate F04 Only, No Class A Passenger Vehicle Restriction None Supplement: 12/12/2012 History Information CDL Permit Class: None CDL Permit Issue Date: None CDL Permit Expiration None Date: CDL permit Endorsements: None CDL Permit Restrictions: None ID Status: None DL Status: VAL CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: VAL ELG Excepted Intrastate None ;:nation rl to Convictioo oota AGO E.Planailan Couoty 3UR 02/08/2011 03/08/2011 'NOS Fail to Yield Right of Way Johnson IA 08/31/2012 12/13/2012 F04 'Seat Belt Violation Johnson 'JA 11/08/2012 12/12/2012 E92 ,Speed (10 mph & under in 35-55 mph zone) -Linn Lk Accidents - Accident involvement indicated does NOT mean the Individual was at fault or given a citation. ik" da'rt Dat' Case Number JUR 04/2612007 .....'368947 9A 02/08/2011 :617539 ]A Name: Morrow, Bret Allen DL/ID: 075AA3630 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department or Transportation, do hereby comfy 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 certity. In witness whereof, I have caused my signature and the seal ditto Department to be set upon this document, at Ankeny, Iowa this date: G - V IRICUy"ea =�. PV2, r e r n --j'.�s�ly ,isr%�3 T IOWA two, 9/18/2015, N N� iiigy-- Office r" G))s 3 k '& of Jews Department t of Tiver ransportation ansportation 1✓ f43 Name: Morrow, Bret Allen DL/ID: 075AA1630 State of Iowa Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apeuido (mandatory) First Name Primer Nombre (mandatug4 Middle Name Segundo mmnbre (recommended) Date of Birth Fwho Normaento (mandatory) Gender Genero (mandatory j Social Secutity Number ('recommended) E7 X13" %6 1Vlalc O Female YH_ lfi 6-50 / Walveer'Si g nature Pima (if the request ism yomrself, please sign. Ifthe request is on someone else, write N/A.) °`t LS° °�Lr Results As of ' a name and date of birth check revealed: -- u ---� ❑ No record found ys nl [Record attached DCl # �yr' 77�.Sjn�i"i _,. �;.- M 70 C:) U) - Ci DCT initials tit Z .C' N 0 Receipt Number of requests x $15.00 per last name— Total amount 7 $ f ,5. O b e� V _Q Method ol'payment: ash money order check # Master(�ffrt or Visa Cardholder's name }^ o DCI initials Iv Credit Card # Exp. Date 13CI-83 (09 / 09 / 10; Revised 10 / 1 / 10; form reviewed 08 / 11 / 14) DCI:00299366 NAME: MORROW,BRET ALLEN DOB SEX RAC 19640403 M W ADDITIONAL IDENTIFIERS SC CHEST 01 ARRESTED 19830115 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI 00299366 PAGE 1 OF 1 DATE PRINTED - 2015/09/18 HOT WGT EYE HAIR SKN POE 602 345 GRN RED MED IA CCH RECORD *** AGENCY: IAOS20100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708-1 ASSAULT TRY.#: L23192401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-1 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23192401 SENTENCE DISP EFF DAT JAIL 30D 19830413 COURT COSTS $9 19830413 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 HE 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 r,.a s COVERS THE SUBJECT OF YOUR INQUIRY. — 37�4GJl DIVISION OF CRIMINAL INVESTIGATION_,,.-., [+9 Po 72 C;` 1" p C.J