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Home My WebLink About15-275':r ®4at *Rr�_ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. )5 -FIs (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 Last 1. Name (REQUIRED) nnz J4lr-a 2. Address (REQUIRED) /,202c C-- C�Sr 3. Contact Information (REQUIRED) Email: 8A -L= A -L (All te,,, �l r,,, Cell Phone:c3l) "4/.asR-S wnn a,(a sent email) 4a. Chauffeur's License expiration date (REQUIRED) Qj - /a/ ,gc7an b. Taxicab Business Name (REQUIRED) Z� LQ 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? i124, Type of offense 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 EQ io 0th", ./ �� i_ What happened to the charge? (Circle one) Convicted 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? ntz) 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) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST 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 VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 2a7 7xaj1iLl issued on expiring on I understand that if I falsely answer any questions in this application, that this appli a�c tion may be denied. ag e�aking 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 Applica � Date)/ -JO- /. L STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by�� . ��n P� (J S on this &D 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 Code). Expiration date of Chauffeur's license > I t `"i /z o2- o 1 Signature0 iefordesignee l l ho2 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. Signatbre of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date Cle mvMoRmeaDcenaaL92014 mended.Doc 0312015 AC Iowa Department of Transportation Ci m- 0 Drw �Seivt-m 1 foil F ree) }3W 5321121 FO 8cp: 9704. DCS MoinLS, EA 54386 9204 514-244 9424 I -.+A1C. 515 239 1.TY Certified Abstract of Driving Record Inquiry Date: 11/4/2015 DL/ID #: 627XX6064(IA) Customer #: 2375713 Name: Phelps, Gilbert Allan Class: A ID Status: None Address: 1206 E COURT ST Audit #: 9079785 DL Status: VAL 02/05/2013 02/25/2013 Issue Date: 05/13/2015 CDL Status: VAL City/State: IOWA CITY, IA Expiration Date: 05/14/2020 CDL Cert Status: Non -Excepted 522403234 zone Intrastate Endorsements: L CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: Corrective Lenses, Restriction None CDL Intrastate Only Supplement: Date of Birth: 5/14/1958 Mailing IOWA CITY, IA Sex: M City/State: 522403234 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/19/2011 09/21/2011 _ M14 Fail to Obey Traffic Johnson IA Sign/Signal 02/05/2013 02/25/2013 S92 Speed (10 mph &. Buena Vista IA under in 35-55 mph zone Name: Phelps, Gilbert Allan DL/ID: 627XX6064 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' roti 11/4/2015 .......A lom D D. T�� r Office of Driver Services Iowa Department of Transporation Name: Phelps, Gilbert Allan DL/ID: 627XX6064 ts»�No it�v, 5, 20,1531U;34AMcdeDly of Criminal Investigatlon (FAx)37s-3az�No.0322 P...1/1,;oC2 13 @i` n�pi STATE OF IOWA f.Criminal History Record Check.Request Form :':n:�w i'•jjiilc DCI Aoeount Number: 9967-F (rrnppueable) To, Iowa Dlvlelon of Criminal Investigation From; 'Yellow Cab of Iowa City F, Support Operations Bureau, 1" Floor O , Bo—X4: 18 115 L 7" Street Des Moines, Iowa $6319 Iowa City, A. $2244 (515)725-6066 515 725-6080' Fax (319)338-9177 Phone! Fax! (319) 339-701 I am mouastinu en rnwa Criminal Mlutnm Rertnrd (^.h�n4 r,n• Last Name (manwo) First Name (manduo Middle NftMe recommended) r Y A• Date OT Birth inmdeioryl Gender (rrmduary) Social -Se urity Number (reaommarldea S_/<� �Ivlaie ❑Female h� /a/ 6 b Waiver Information., Without a signed walvar from the subject of the regttest, a eornplGte tr minal history record may not be releasable, per Code of Iowa, Chapter 692.2. Foroc mnlete criminal history•recor4 larormgtl n, as allowed by law, always obtain a waiver signature from the subject of the request. Waiver Release:I hmbyglva pamisslon (sr the above raclueaune ofrjolel to conduct an rowa odminal hlnoryrooard oheek with the Dlvfalon ofCrlminel _inverdgel(oat4Ct),_6py�rlmtoa(hlUary�leta_cortesminsmo[hit Jsnfelnlglnad.bynhtpCtmeyberooasad,uellowegbylow. „__ WaiverSignaturBr t'a P Iowa Criminal History Record Check Results (DCl aaa only) As of a search of the provided name and date of birth revealed: I¢! No Iowa Criminal History Record found with DCI _! c , 0 Iowa Criminal History R000rd attached, DCI # DCI inititls DCI -77 (08/25/I0) Rtcelved Time Nov, 4. 2015 1 45PM No, 1401