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Home My WebLink About15-293� r 1 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 J/ eb°r4l First Middle La 1 Name (REQUIRED) p J (q 0 L��d 2. Address (REQUIRED) 75 S; /lam rr/L.,y l 19", / Loy l Cs ��<j/ 3. Contact Information (REQUIRED) Email: SG P B r— f X v Ce h j?d G Ina Cell Phone: (All Written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) %. 2, 20/9 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? Type of offense // Where When l L %cif C c +G6 ee�% o W e"Se, rh Q` sAoo/fir h,�4 rh41460, 1-7`xcr�2 h� r7 What happened to the charge? (Circle one)' 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 f,�oluy �71U47 /UGG i-4 Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty r Ot'hert,) 8 Has your driver's license or chauffeur's license been suspended or revoked in the last five years ' a Type of offense Where /, o � � when r 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the names) 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 &4 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby cern that I have issued to pie by the Iowa Department of ansportati a valid Ch uffeur's license number c/ 7 C?D `/ issued on � a -27r �x iring on,,�. I understand that if I falsely ans;W& an 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 Tit 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant e Date c '-� 'q '�? (::5, /S STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Stf.U2ut -4 C-,trvr on this IPD day of -r\a t r-" L. F— W)[5 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). date�F��hauff'r's license ( Z 7 ! G or designee 1z/flip ae 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. Ct-c Lam.✓' :' -444) o Signatu e of City Clerk or designee Date Clze7a 10Rivenoce PPLe2014.m.�deJ Doc 0312015 Office Use Only C5 Approved application DCI report r� r State certified driving record Website update a u„ Clze7a 10Rivenoce PPLe2014.m.�deJ Doc 0312015 d•lum D l v of Criminal Investigation No. 2433 P. 1/2 L161 "N Wd6S:ll SIOC 'OL 'AONlaa:il Paa = . STATE OF IOWA VtS. I. Criminal History Record Check Request Form �1 a DCI Amount Number: 138!'FL {Ir.orelael�) To. IowaDIYNbuofCrfmlualDIVU11gaduo I•Yomr May "rll)rl Support Operations 10areau, )a Floor xis li.7a street 4 rj� tNts.a pr Des motraw swig _ A 539 b '��— tiAhdm: Fur.. 9l9 SSI' a r4i,.:—I Hkm. k rn,.l Cherk ons List Name Lms�- — First Name meodr I Middle Name ywemaasdw re ✓ern et V% — Date of Birth a. Gender naaddo SocialSecu Number roes . p 7 Ct% g - I / f / Male ❑Female f 7 I / , {/ e2 N� 3 Walter itl ormaflonr Wflhoutp signed waiver rmm the subject orthe rational, a complete erhntool historyrecord may not be relatable, per Code of Iowa, Chapter 4M2, For eomakta criminal history record Information, as allowed bylaw, always obtain a waiver elpolure hom the sojoqt erthe ircgoefft Waiver Release: lbnnbygin Pamin t,ronhe.mror8q=dRKOr1kww WWW a, low.ahomwhimly.R Wmakwith daDinsimarcominel lnwgip, ..(DQ). Any uimind hlawY dsa Conaanlna la.I6vy+ main imobyde D�C[I=yrwrdmadodlawdbylew. waiver Slgnalwa: Bowe Criminal HHistort Record Check Results tnclas<edy) As of 31 a soarch of the provided Dame and date of birth revealed; ❑ No Iowa Criminal History Record found wilh DCI Iowa Criminal History Record attached, DG N b a( i CA DCT initials — L DCI -77 (08125/10) Dec. 1. 2015 4:26PM Div of Criminal Investigation No. 2433 P. 2/2 DCI:00706957 NAME: ORROT, STEVEN ALAN DOB SEX RAC 19570922 M W ADDITIONAL IDENTIFIERS 01 ARRESTED 20030912 IOWA CRIMINAL NISTORY NON CONVICTION HGT WGT EYE HAIR 506 200 BRO ORY CCH RECORD ... Oct 00706957 PAGE 1 OF 1 DATE PRINTED - 2015/12/03 SRN POB IA AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(2) THEFT 2ND TRK#; 100953201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA714.2(2) TREFT 2ND DEGREE - 1978 COURT CASE ID: 06521 F9CR066430 CHARGE CLASS: NON CONVICTION TRK#: 100953201 RESTITUTION SENTENCE DISP EPP DAT DEFERRED JUDGEMENT 20040709 PROBATION 3Y 20040709 DISCHARGED FROM 20121207 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 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 CON1Vwa Department of Transportation otki of C}naer S rr res ('1041 Ffee) i 53r2 1121 P{3 13m 9204, Des Moi&s, lA 50306-9204 5152444124 4 AX 515.2391#3? Certified Abstract of Driving Record Inquiry Date: 12/7/2015 DL/ID #: 959ZZ3004(IA) Customer #: 1549690 Name: Genet, Steven Alan Class: A ID Status: None Address: 2254 S RIVERSIDE Audit #: 7647396 DL Status: VAL DR TRLR 42 City/State: IOWA CITY, IA 522465850 Mailing Address: 2254 5 RIVERSIDE DR TRLR 42 Mailing City/State: Convictions IOWA CITY, IA 522465850 Issue Date: 12/27/2013 Expiration Date: 09/22/2018 Endorsements: LNT Restrictions: NONE Date of Birth: 9/22/1957 Sex: M History Information CDL Status: VAL CDL Cert Status: Non -Excepted Intrastate CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Ex lanation Count ]UR 02/05/2015 07/07/2015 M14 Fail to Obey Traffic Sign/Signal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]UR 02/05/2015 _ 1843960 IIA Name: Genet, Steven Alan DL/ID: 959ZZ3004 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: