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Home My WebLink About16-0190 too -vim MIiM�rri; o CITY OF IOWA CITY 410 Fast Washington Street Iowa CitV. Iowa 52240-1826 (319)356-5040 (3 19) 356-5497 FAX IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PFDICAR VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) C -f 64b First iddle i. Name (REQUIRED) Srt Fi rj E % e 2. Address (REQUIRED) = � � G✓ �; `G�� L 0 3. Contact Information (REQUIRED) Email: C9 L.,. /j e n 6,/ r5i f (All w itten communication sent via email) 4a. Chauffeur's License expiration date (R6QUIRFD)^ b. Taxicab Business Name (REQUIRED) 5. Prior xperience in transportati n of passengers: OBJ Car b �o 9 Qy 910 81ac1� •r W �-� _ 03 Last II Phone- VC hone: V sfar pIV10 6. Have you ever been arrested I charged with any misdemeanors and/or felonies in this State or elsewhere ' O c Type of offense I Where W hen — o a �tRv ' fa D �a ai-t'krr e What happened to the charge? (Circle one) fl-fonvictod Dismissed Deferred SuspendedPlead Gu 1 �'1 Other 7. Have you been arrested I charged with any traffic offenses in the last five years? c ow' T o of offense �- ( �O Bf� �, ere When f�t4` �/ r� a W AASon s I ! to Q ra �asl f5 a' � r( l LSAG 1✓.- n r1 A iD/l Z oq / JL What happened to the charge? (Circle one) anvicte Dismissed Deferred Suspended Plead Gu'lity Other 8_ Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ ?,� i 5', i Sr>�ncfetf�' Type of offense Where �— ift, -Fa 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please • n DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE Cts TIFl DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CH]tREVeW M You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0122015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I herebyncehil9that I have issued to me by the Iowa Depdrtment of Trans ortatinr� valid Chauffeur's license number 3 f i y S issued on r>"flo(4 _expiring on <?5 c' 3 U _ I undo stand that 'rf I falsely answer any 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 at 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, Chapter2, of the City Code. (Needs to be signed in front of a Notary Public) / r Signature of Applicant Datetfr �ir?oli iiiik+%#*k. 4�{*#k*ki_xr....rk%#%rt+k*h#-xxxxh+.yk,y%x} _kkiaGi*#A*tiktx-y%%µp{{kkk xkxx#[-k** xkxx rksy}iy,*F+��xr+3µµ ke:[�+r.>*moi k#kkxka'#xxa+*%f. STATE OF IOWA ) COUNTY OFJOHNSON Subscribed and sworn to before me by s ag �� h Sfi r pct _ vs r _ r on this day of in a k31{k#k##k{#k*xxY{k{}{**k*h**i.artxFxkk##}kk*;xi%#}}#;Y#{k*Rkkkkhkhkkkykk*#*kkk£k;kkk*k#*kxkk#kxk;h#YkYkk*kk#;kk#}k*ki;#kh#s4k;;**k3;k##kk4µRkkxx# 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 ildicate that the issuance vrould be detrimental to the safety, health or vrelfare of resi- dents of the C Iowa C/07yTitle 5, Chapter 2, City Code). license or abate 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. c SiI` of City Jerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date CIertJ 1 DRNBADGE,SPP14)Mnz-nan�EC. DOG 03!2015 ry c� u�.3 ..a a 3� ca CIertJ 1 DRNBADGE,SPP14)Mnz-nan�EC. DOG 03!2015 I Inquiry Date: Customer #: Name: Address: 10/1/2015 1925346 ✓ DOT SIMARTH € 5E1AEF t (USTG64:k WWII Office of Driver Services PO Box 91204 : Des Molnes, iA 503044204 Phone: 515-244-9124 [800-532-1121 1 Fax -973239-1837 wvt,ti'.iauadol-gov Certified Abstract of Driving Record DL/ID #: 332AE1495 (IA) CDL Permit Class: None Class: D Kenner, Samuel Joseph Audit #: 308 E BURLINGTON ST Issue Date: APT 106 City/State: IOWA CITY, IA 52240 Mailing 308 E BURLINGTON ST Address: APT 106 Mailing IOWA CITY, IA 52240 City/State: Corrective Lenses Date of 5/3/1973 Birth: IA Sex: M Convictions 9189893 06/23/2015 Expiration 05/03/2022 Date: explanation Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: IA History Information CDL Permit Issue None Date: COL Permit None Expiration Date: explanation LDL Permit None Endorsements: -02/28/2012 CDL Permit None Restrictions: IA ID Status: None DL Status: VAL CDL Status: None CDL Permit LLG Status: .Fall to Yield to Emergency Vehicle CDL Cert Status: None CDL Med Status: Nene Citation Date Conviction Date ACD explanation County JU 12/12/2011 -02/28/2012 :M14 fall to Obey Traffic Sign/Signal Johnson IA 10/05/2012 02/13/2013 M14 -Fall to Obey Traffic Sign/Signal Johnson :IA 10/25/2012 12/0N2012 N04 .Fall to Yield to Emergency Vehicle Johnson IA 01/25(2015 -04/09/2015 M14 -Fall to Obey Traffic Sign/S)gnal 'Johnson STA Sanctions T;rpe E'fective End ACD Erplanation occurrence JUR 111.: Suspended 03/30/2013 .06/27/2013 Wo1 Habitual Violator [A IA Suspended 01/02/2014 01/22/2014 863 Fall to Reflle SR22 IA ]A Suspended 09/16/2014 11/24/2014 ,B63 Fall to Refile SR22 IA IA Name: Kerman, Samuel Joseph OL/ID: 332AE1495 Pursuant to Iowa Code §321.10, 1, 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 he set upon this document, at Ankeny, love this date: F„ 49APD Diu of Cruallnal 1gve3li"dh10r ho, 072 2 D r27 U r +_.ny Cio•K �r,.,co u,m _sod. mi aP12 T/YOT6 76.61 � �. . v.uu2/vo. To: ]awa Divlslon utC'rinlinal blves¢Igalian 3upporl ffWMionx $urea u, I" Fluor 215 ri. 71" 5tjE*& Acs Molim, Iowa 50339 (5) 5) 725.6066 (515)725-6000 Pax HD ��1�i•� 11G� Check e� DCl Acmlml tdun,ber: T_L-4 iii applicehfe) — Isi-om: Ci(yuflaw'd city City cierlt' OOfff— ¢' 630 E,'Lawn kllk 6itcef ror+e Cihy, IA 82240 I'hmae: 319-=56.5041 Rax: 319�i56•S-~ 497 .�--� -•— Male ❑Female ........ Arlfur»laffprt: Without a sl ncd waiver ---�� he "J"S pie, per Code otYowp, Chanter 692.2. ,For eerti� I�ete�rlminalht sio U rec a complete criminal hjstory record d of Ohlaln A 1YiilreT Si h8[yrC fiUm the Seh erl at SAE 1'et]neSf. a ol•d ihfo) rae on' as pllolVed by 1plq, alaya)'S q'RdVef RelEase:lL=rcby ghee Permission foe the above requesting officio}to wnduata,]pweI'minal bismry'40'd'1!KP with rho Division 01 C'hvui' i Invettion(iWt (DCIJ. Any 6nib tnl hi,tney dale conn<nvng me ll;al l^ -4 aiJU d by ilm ACl only he fdeascd as ellowW by lew, 1 waiver Sfgnadare: Iowa Criminal Histor r Record Check Resalts [DCI usb only, As of d_ / — — ` a St aych of the provided name and dale of birth revealed i7 Mi Iowa Ca i'Dipal Ais¢ory Record found with DC? Iowa Crinurul! Hillary Record at¢ached, DCl� /J• 3 7 DCI initiate r Receivl6 Time SeD.91. 9015 1:51PM 16a.6492 3ep.2', 2015 11:49AM Div 91 Criminal JnvesIigaIion IOWA CRININAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00451531 NAME: K6NNEN,SAMUEL JOE REHREN,SANVEL JOSEPH RENNON,SANVEL JOSEPH DOB SEK RAC HOT WGT EYE 19730503 M W 603 190 GRN DCI 00451531 PAGE 1 OF 3 DATE PRINTEC- 2015/09/23 HAIR SYN POs PRO PAR TN ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19921218 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA3210-2 OWi TRK#: 1,43115001 COURT DISPOSITION AGENCY: 1A052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J,2 OPER VEH WH INT OWI CHARGE CLASS: M15DEMEANOR CONVICTION TRK#: L43115801 RESTITUTION SENTENCE .TAIL 48H FINE $500 02 ARRESTED 19950326 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- Ol. IA STATUTE IA321A-3i DRIVING UNDER SUSPEND TRK#: 014624201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 SA STATUTE; IA321A-32 DRIVING UNDER SUSPENSION CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 014624201 SENTENCE FINE $250 03 ARRSSTSD 19950406 AGENCY: 1AD520100 CORALVILLE PD CHARGE NO- O1 IA STATUTE IA321A-32 DRIVE UNDER SUSPENSION TRK#• 014626201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: 2A321A-32 DRIVING UNDER SUSPENSION CHARGE CLASS: MISDEMEANOR CONVICTION DISP EFF DAT 19930910 19930910 DISP EFF DAT 19950519 No. 6722 F. 2/9 sfv.21 2015 11:49AM ii v c C r i n nal investigation TRK#: 014626201 SENTENCE FINE $300 04 ARRESTED 19950524 DCI 0045153], PAGE 2 OF 3 DISP EFF DAT 19950519 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- O1 IA STATUTE IA321A-32 DRIVING WHXLE LICENSE SUSPENDED TRK#: 012726701 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE; IA321A-32 DRIVING WHILE LICENSE SUSPENDED CHARGE CLASS! MISDEMEANOR CONVICTION TRK#: 012726701 SENTENCE DISP EFF DAT PLEAD GUILTY 19950611 FINE $350 19950611 05 ARRESTED 19960417 AGENCY: IACS20200 IOWA CITY PD C14ARGE NO- 01 IA STATUTE IA124-401(3) POSSESSION/SCHEDULE I/MARIJUANA TRK#; 024159501 CHARGE NO- 02 IA STATUTE IA727-2 SALE OF FIREWORKS TRK#: 024159502 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO OX$T COURT COUNT NO- 01 IA STATUTE: IA124-401-3-2 POSSESSION /CONTROLLED.SUBSTANCE/SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024159501 SENTENCE DISP EFF DAT FINE $300 19960906 COURT DISPOSITION AGENCY: TA052CIE17 JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA727-2 SALE OF FIREWORKS CHARGE CLASS: MISDEMEANCR CONVICTION TRK'#: 024159502 SENTENCE DISP EFF DAT FINE $250 19960906 K< . 6722 P. 3/9 Sap.23. 2015 11:490 6iV of Criminal 1nVtsfigaifon No, 6722 P. 4/9 DCI 00451531 PAGE 3 OF 3 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU CF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINT5 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 r