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Home My WebLink About16-020I CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319)356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. i � ` CID (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 3. Contact Information (REQUIRED) Email:, 'T& (All 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) _ (- IT 5. Prior experience in transportation of passengers: -14 ez- (?,*s.,Sam L/b !<�crSGnC MctiS'+.ion—Cell Phone: 3f 9 3 t- 7�y5 ten communication sent via email) 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? �S I Where li' I I U 4,v� a_ A;Z—LS What happeneoVto the charge? (Circle one) When Convicted Dismissed Deferred Suspended Plead G ill ty Other 7. Have you been arrested / charged with any traffic offenses in the last fivg.years? SIC S Type of offense Where When Ut -I S Aa --p 5kA = .1c C- LikII What happened tole char�e? (Circle one) Convicted Dismissed Deferred Suspended Plead G it Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1-10 Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provideaheip�ame(s') `7 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 De art ent of Transportation a vali{l Chauffeur's license number Q21 XX `Zl Z issued ons t� expiring on�a+�r�j T I understand that if I falsely answer any questions in this application, that this application may be denied. 1 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 Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant I LX�� Date 2_/j I ( (' STATE OF IOWA ) COUNTY OF JOHNSON ) / cribed and sworn to me by lC�-YL Lcz r' so/,) on this St day of _ , KFLUE K. TUTTLE Notary Public in and for the State of Iowa 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 ::?K3/2,)/-6 22/Z 1 Signa tur Chief or designee 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. Signa crr"f City Clerk or design e Date Office Use Only 0 r m Approved application —' s DCI report State certified driving record Website update �a ---I Cle, rAXIORIVB GE PPL92014an,e„deaooc 0312015 47JiU%NjAkD0T ANVAMi0wadotgov SMlARTER i SIPAPL: F d CUSTOV,-F, DRI'VE'd.� Office of Driver services PO 601, 9204 Des Moines. IA 50306-921.4 Phone _515-244-91241800-532-1121 1 Fax--575-239-1937 www'io'?/ado, q0'r Inquiry Date: Customer V: Name: Certified Abstract of Driving Record 1/27/2016 DL/ID #: 431XX7942 (IA) CDL Permit Class: None 900797 Larson, Alan Keith Address: 1540 PLUM ST City/State: IOWA CITY, IA Convictions Class: D Audit 7r: 8839758 Issue Date: 02/12/2015 Expiration 07/13/2016 Date: Endorsements: 3 CDL Permit Issue None Date: CDL Permit 522402124 Mailing 1540 PLUM ST Address: None Mailing IOWA CITY, IA City/State: 522402124 Date of 7/13/1954 Birth: None Sex: M Convictions Class: D Audit 7r: 8839758 Issue Date: 02/12/2015 Expiration 07/13/2016 Date: Endorsements: 3 CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: 04/08/2011 CDL Permit None Restrictions: ELG ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: 04/08/2011 S92 Speed CDL Permit ELG 03/26/2011 Status: M14 Fail to Obey Traffic Sign/Signal CDL Cert Status: None CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation County IUR 03/25/2011 04/08/2011 S92 Speed Johnson IA 03/26/2011 04/13/2011 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Larson, Alan Keith DL/ID: 431XX7942 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: IWA •+ O� 1/27/2016 Qg D. 0. T. q„flivq-- Office of Driver Services F,Jan, 26. 2016,,9:51AM�,.,Div of Criminal Invest fgat ion No. 6019 P. 2/3 -- •-••.--••• 01/22/2010 ls:-- 036. 002 STATE OF IOWA Criminal History Record Check Request ff+oriin "ro: Iowa IDivilion of evinrinal Investigation Support Operations Bureau, Irl Floor 2151 U7" Strect Des Moines, loH•a $0319 (515)725-6066 (515)725-6000 Fax I am fe uestillall Iowa Criminal History Record Check on• DC1 Acconnt Numbcc �r 7 iii appl"blt) From: -City nS Iowa City City Cleric's Office 410 C, Washington Street Iowa City, IA 52240 Phone: 319-356-5041 Fax: 319-356-5497 Last Na1nC (m-andatory) First Name (nandatory) IViiddle Name (re �mmended) L il' A S v N (Q Dateof Birtb (nandalo .) Gender (maadaw y) Solciiaall Security Number (recommenard) / SrLI 16Male ❑Feinate /� �S' 2-- 3 b I b Maiver Inf0r11106011: Without a signed waiver from tate subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2, For complete criminal history record Information, as alloyed by law, always obtain a waiver signature from the sub•ectofthel"e nest. Waiver Release; l hereby give permission for die above regncsting of ieinl iu ccoduct m Iowa uiminal bistog4 mord check wi Ih the Division orcriminal hmestigatinn (DC), Any criminal history data eonccrn�g methei is mainlain/etl'by the DU m y be rdcpscd as ellmwd bylaw, Waiver,Signatare:__ 6/ K — , Iowa Criminal History Record Check Results As of lL� (y�/fP a Search of the provided name and date of birth reveale(E., No Iowa Criminal History Record found with DCI T Iowa Criminal History Record attached, DCI # 5� D(,'I111it1aIS_,��.t� _ L)U-7! (U6/23/1 0) Received Time Jan,22, 2016 2:14PM No -5914 `(DCI ussanly) N Ctsl L9 Jai (� o D J ao26. 2016 9:h1AV Div of Criminal Investigation No.6Q79 N. 3/3 IOWA CRIMINAL HISTORY DCS 00567329 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00567329 2016/01/26 NAME: LARSON,ALAN KEITH D013 SEX, RAC HGT WGT EYE HAIR SKN POB 19540713 M W 601 200 BLU PRO FAR IA ADDITIONAL IDENTIFIERS SC FHD CCH RECORD **+ 01 ARRESTED 19900111 AGENCY: IA0050100 AMES PD CHARGE N0- 01 IA STATUTE IA124-401-5 POSSESS CONTROLLED SUBSTANCE TRK#: 032094601 COURT DISPOSITION AGENCY: IA085015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401(5) POSSESS CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 032094601 SENTENCE DISP EPF DAT FINE $250 19980331 COURT COSTS 19990331 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