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HomeMy WebLinkAbout15-266CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. 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 First Middle 3. Contact Information (REQUIRED) Email. h rY)_c dyLlwnn �IL�J ( a /( 1ene Jq D (All written communication sent v email) 4a. Chauffeur's License expiration date (REQUIRED) /0/23za?ca6 b. Taxicab Business Name (REQUIRED) _ ���((pt.) C-C,� C-0. 5. Prior experience in transportation of passengers: 2,9 ,.t Sid,,, o ssl J 1— 4 eat q a cl - a 0 owl `fit- -)w.e- .�, r v C/- oy 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tvpe of offense d2-��erbe, l 5..,- l �M�.•-fir What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested /charged with any traffic offenses in the last five years? Type of offense Where When U 11 C¢- yJt_o..Jq - c, Ce jqq&- What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Otherc 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 44--10 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) /tel/d DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE,LERTI ED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHDF.rF %VIEW You must apply for an individual Department of Criminal Investigation Report (form ava)Igfik urequeat). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTAR- d r a r j 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that t have is�s ued to me by the Iowa Department of Transportation a valid Chauffeur's license number e� eC71"m 0{�vy issued on Io expiring on to . I understand that if I falsely answer any questio s in this application, that this appli atC ion may be denied. I agree at 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, an er-agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provision of Titl City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant a�— Date txFh###****kkh*k*kW%W%kWkxWk%kR*WkW*W*WkWWk%WWkk*hW#WWA'kkkWkikhkRWWW*Wk***WkhhhkR*W%*-k*W**%WhWWWk W#**kW*WWW*%*************t**********k********** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by A PAc ,l k( -U on this _PL) day of C-)( 4 aol(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 orwelfare of resi- dents of t�kCity of Iowa City (Title 5, Chapter 2, City Code). Expi or license ( D j n -Z L) 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. Sign re ohCity Clerk or designee Approved application DCl report State certified driving record Website update ee7/ar/Z ate �a -_d c C:) +i Office Use Only o ;nary; Geral MIDMN DGE PPL92014...nded.DOC 03/2015 - •v aw as a. w �rr araa a.awawaa a. v a w + awa ay�r ry w a.aw a.. v as W VM1 { I r,,ll) r00I >il h '+.7 1121 `+1& 244 ,4 124 f ata( t1 h_.t Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 10/13/2015 DL/ID #: 123BB9480(IA) Customer #: 3842402 Name: McGlumphry, Mark Class: D ID Status: None Alan Address: 220 WINDFLOWER Audit#: 9492463 DL Status: VAL LN Issue Date: 10/13/2015 CDL Status: None City/State: SOLON, IA Expiration Date: 10/23/2020 CDL Cert Status: None 523339453 Endorsements: 2 COL Med Status: None Mailing Address: 220 WINDFLOWER Restrictions: NONE Restriction estri Supplement: ent: None LN Date of Birth: 10/23/1970 Mailing SOLON, IA Sex: M City/State: 523339453 History Information Convictions Citation Date Conviction Date ACD Explanation Cou 1111 1, 7UR 09/25/2012 10/19/2012 S92 Seed Polk 11A Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: McGlumphry, Mark Alan DL/ID: 123889480 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department or 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 V,Iowa Department of Transportation to so certify. r`" CD In witness whereof, I have caused my signature and the seal of the Department to be set upon thisooGumeMO at Ardcern, Iowa cA t this date' re: McGlumphry, Mark Alan DL/ID: 123869480 Office of Driver Services Iowa Department of Transporation N G'1 }F aq CNA ��i 10 Oct.26 2 20159'27AM Dlv of Criminal Invest) ati3n No.9311 P. 1/2 _„� Cae w .. (FA%)3183382.r��.</002 gCriminal History Record Check ���STATE OF JOWA i^'ipS°:4"f1i ::latgra`.. Request • X r DCI Account Number; 9967—F ~^ (Irappuoab)s) Tat Lowe Division orCr(minol Investigation From: Yellow Cab of IOWA City Support Oparatlons Bureau, I" Floor P,O, Box 429 215 Z. 7r^ Street ' Des Maines, Town 50319 Iowa City, IA. 52244 (515) 725-6066 ax (319) 398-9777 Phone: Pax, (319) 339-7302 I alai ragUestln¢ an Iowa Criminal History Reonrd Chenk nn, LastNnine mandatary) Flr9t Name (mandato Middle Name (racemmendad I?a to of glYth mardno ) Gend�elr—mandato ) SocieJ SeCuri Nuiiifi rr (rae/cymmanded)(� 1 0Jj7(� (��� 'r�<Ia ©Fetnule /�7 Walver11{f0rmal10rtr Without a signed waiver from the subJect of the rogpost, a complete criminal history record m7nolbe rehosable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed bylaw,al obtain a wnlver sl nature from the sub eat of the rp uost, WOIW RCle=e; I hereby glue porml;iton for the abo4a mNvwting onlalal to Oondeo: M Iowa Criminal history record chook with the DIvleion of Criminal Invw1galion (DCI). Any erlminol hlsrory date conn ruing me On: IS maaimalcncil Y I�ho DCI may/ est ns e o w. Waiver Signalure: �o / 0- f14 Iowa Criminal History Regolyd Check Results (DClueaonly) As of (}-Z(o" a search of the provided name and date of birth revealed; � .r ❑ No Iowa Criminal History Reoord found with DCI y Iowa Criminal History Record attached, DCI 4____51 DCl initialslyj --_� DCI -77 (08/25/10) Received Time Oc1.21. 2015 9:26AW Itlo.0499 Oct26. 2015 9�28AM Div of Criminal Investi;ation IOWA CRIMINAL HISTORY DCI 00566563 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2015/10/26 DCI:00566563 NAME: MCOLUMPHRY,MARE ALAN DOB SEX RAC HGT WGT EYE HAIR SKN POB 19701023 M W 600 195 BLU BRO MED TA —AD AL'LIANAT.—LPBNT�-F+F&Re SC CHIN SC L EYE TAT L ARM CCH RECORD "** 01 ARRESTED 19980104 AGENCY: I.k0770600 WINDSOR HEIGHTS PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 024265101 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2(A) OWI -1ST COURT CASE ID: 05771 0WOM047111 CHARGE CLASS: NON CONVICTION TRK#t 024265101 SENTENCE DISP EFF DAT PLEAD GUILTY DEFERRED IY,S/A EVAL,OWI- 19960313 IST PROG,50HRS C/S DEFERRED JUDGEMENT 19980313 COURT COSTS 19980313 PROBATION 1Y 19980313 DISCHARGED FROM 20210701 DEFERRED JUDGEMENT 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 DCT. 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 Y No. 9311 P. 2/2