Loading...
HomeMy WebLinkAbout15-284III cccccvz CITY 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. 1 (Office Use Onl 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 3. Contact Information (REQUIRED) Email: -3AUC V kC <-% lLi�c m41 (< Co KA Cell Phone: S30 cA'`(Arj (All written communi ation sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 1 (G �T 7 —�QI b. Taxicab Business Name (REQUIRED) �:e (1UW 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 When 2006 What happened to the charge? (Circle one) 11 Convicted Dismissed Deferred Suspended PleadGuiltyOther 2Tefed D 7. Have you been arrested / charged with any traffic offenses in the last five years? a�t F S Tvpe of offense What happened to the charge? (Circle one) Where C; R When Convicted Dismissed Deferred Suspended Plead Guilty thea evt fcize�— Has your driver's license or chauffeur's license been suspended or revoked in the last five years? U Type of offense Where When 9. HaM1 ! 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 he eb certify ha I Piave is ued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5 �7—_5_(� issued on IU-(-�U177expiring on (0-0y2)-dbI I understand that if I falsely answe any questions in hi— ion, 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, it authorization to be a taxicab driver is granted, to comply at all times with all of the provisions)ofTitle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant 2s(� Date-[( - (S- I (j v STATE OF IOWA ) COUNTYOFJOHNSON Su scribe a d syvorn to before me by `J �� j . L� on thisI pp 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 __ ( Jug 120 IS Signature of Pdjice Ohief or designee ,lit I�5 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. �GG�✓L// H/ /� / GG'�YJ Sign re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date Clerk( MDRNBADGEAPPLKOI 4 wndedDOG 03/2015 11Aov_10, 2015D1;2?PMCae Div of Crimlnak Iovestigatioo (FAX)3193382NO,O669 P*1, DzVOQ2 ISTATE OF • �rfi.!Ti,VCriminal HistoryRecord Request Form t��(re tot tCt To: Town Division of Criminal Investigation Support Operations Bureau, 1" Floor 215 E. 7'" street ))as Mothes, Iowa 50319 (515) 715-6066 (SIS)•725-6080 Fax I am reauestln0 en Iowa Crlrninot f•(ienm tt A6nrA r�hww4 nn, DCI Account Number: 9967-F (Iroppllcable) Fromt Yellow Cab of Iowa City _F0. Dox 428 Iowa City, TA. $2244 (319) 3389777 Phone) Fax: (319) 339.7302 Last Name (mandalory) First (mandala ) IMiddle Name (reaommended) 1Nyalme V` V -Date/-6f'Birth (mandatory) (y`dl der mandato NUm er reaomMendad) V" 0 9 > Male ©Female q($ectlrt 7` `" i I— `[;tL40 Waiver Information: Without a signed waiver from the subject of the rotivest, a complete criminal history racard spay not be ral4aaable, per Code of Iowa, Chapter 692,,2, Far oom blot cHminal hlstaryrecord Information, its allowed bylaw, always obtain a walvcr ai nature from the subject of tho re nest, Wolver Release; I hereby give perrnisalon fie Ih bbve req�asling official to conducl.n (own erlmind hlslory record Dheok with Iha Dlvl:tun otCrlminel Inverllgetion(DCO. Myarlminal history data 40 9 ,at is mainlalnedbylhe DClmeyborclapcdass)lowed bylaw, Walver Signature; Iowa Criminal History Record Check Results (DCluse only) As of O (S , a search of the provided name and date of birth revealed: Q No Iowa Cl'iminal History Rcoord found with DCI / (' [Own CrilninaS I-Iistory Rcoord attached, DCT #�� DCI initials �J DCI -77 (08/25110) Received Time Nov. 9. 2015 9:12AM No.0475 W Nov. 10. 2015 1:25PM Div of Criminal Inv e s t l g a t i o n No. 0669 P. 3 DCI:00792126 NAME: ERB,STUART JOHN DOB SEX RAC 19861006 M W IOWA CRIMINAL HISTORY DCI 00992126 NON CONVICTION PAGE 1 OF 2 DATE PRINTED - 2015/11/10 HGT WOT EYE HAIR SKN POB 600 230 ELU BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCA RECORD xww 01 ARRESTED 20061217 AGENCY: IA0520100 CORALVILLE PQ CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VER WH INT (OWI) / IST OFF TRK#: 1AD000201 CHARGE NO- 02 IA STATUTE IA124,401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: 1A000GZO2 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J,2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCRO70161 CHARGE CLASS: NON CONVICTION TRK#: 1A000GZ01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY UNSUPERVISED UNDER DOC COMMUNITY SERVICE 50H DISCHARGED FROM DEFERRED JUDGEMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 TA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 OWOR070161 CHARGE CLASS: NON CONVICTION TRK#; 1ADOOCZ02 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY UNSUPERVISED UNDER DOC COMMUNITY SERVICE 5014 DISCHARGED FROM DEFERRED JUDGEMENT 0 DISP EPP AAT APPEAL DATE 20070409 20070409 20071101 20070409 20071109 DISP EFF DAT APPEAL DATE 20070409 20070409 20071101 20070409 20071109 No v. 10, 2015 1'25 PM Div of Criminal Investigation DCI 00792126 PAGE 2 OF 2 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 ACS. 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, nrVISION OF CRIMINAL INVESTIGATION No. 0669 P. 4 Iowa Department of Transportation CCAW h+l Utc)e of brsvcr bkmces {ltill Freei 3J[t 532 1til Pik t3Dx 3264, [les Mdrtes, to 5C3[75.92a'�t 515 244-9124 13r7C 516 2393� 133 f Convictions Citation Date 12/17/2006 Certified Abstract of Driving Record ACD A20 Inquiry Date: 11/9/2015 DL/ID #: 555xx5019(IA) Customer #: 3919725 Name: Erb, Stuart John Class: D Address: 805 BOWERY ST Audit #: 7394299 ID Status: DL Status: EXP Issue Date: 10/01/2013 CDL Status: VAL None City/State: IOWA CIN, IA 522405602 Expiration Date: 10/08/2018 COL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 805 BOWERY ST Restrictions: NONE Restriction Supplement: None Date of Birth: 10/8/1986 Mailing City/State: IOWA CITY IA 522405602 Sex: M History Information Convictions Citation Date 12/17/2006 Conviction Date 04/09/2007 ACD A20 Ex lavation Deferred Judgment Coun Johnson JUR Ip OWI Operating While Intoxicated Test Refusal/Test Failure Violations Sanctions Name: Erb, Stuart John DL/ID: 555xx5019 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 1 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: yIu(f w, X11 11/9/2015 p.,.......•y� � 10WA# D Office of Driver Services Iowa Department of Transporation Name: Erb, Stuart John DL/ID: 555xx5olg