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HomeMy WebLinkAbout16-021CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. C � I (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: 11\i c; (All wri 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa d1.cyO Cell Phone: 3b -972j6_3433 via email) 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended lead G ther Have you been arrested / charged with any traffic offenses in the last five years. L Type of offense Where �� 1 When What happened to the charge? (Circle one) J / RJ C7 Convicted Dismissed Deferred Suspended Plead Guilty Otter �R— 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five ye�rs'�''�- Type of offense Where ((� gWhen 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) t1 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 3�OC/Z019 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number issued on ri 114 expiring on3�/ I understand that if falsely answer any questions in this application, that this appli ation may be denied. I grey e 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 provisi s f Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date f Z ( STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by �, �h \ G a p on this Z`t` day of Soh g� aot — 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 lute 2.61q _ 3 �1241�n Signatu ot Polide ChAf 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 -tore of City Clerk or designee Office Use Only `T7 e Approved application DCI report !» State certified driving record Website update b C.0 �n aeNTAXIDRNDADGE PPL92014amended Doc 03/2015 oi,Jan.27 2016:42,1OPMCeb6iv of Criminal Investigation STATE OF IOWA (M4 a • i a Che To: Iowa Dlvlsion of Criminal Investigation Support Operatlona Bureau, 1r' Floor TIS E. 7'^ Street Doi Molnes, Iowa 50319 (515) 7256066 (515)725.6080 Pax I om reauestina an town Crimin•I au•r,,.., to ----A nu__._ _ (FAX)31933 L. 6268 P. '1/2 � 1/002 DCT Account Numbor: ^9967-F (lrepplleeble) From: Yellow Cab of Iowa City P.O. Box 428 Iowa City, lA. 62244 (319) 338-9777 Phone: Faxt (319)339-7302 Last Name tmandat 21' First Nam* (mindato ' Nllddle Name (recommended P) OAQ - (Va1h n Date of Birth (mendate iiender (ma atorySOc1a1.6ecUrl Pumber recommended b %2S ,. ale ©IzomaIe 02 - ',,Ov��J 7 Waiver T formalion: Without a signed waiver from the subJeet of the request, A complgte grlminal history record may not be releasable, per Code of Iowa, Chapter 6912, For coal criminal history recon¢ Information, as allowed bylaw, always obtain a waiver signature from the subject of the request. Waiver Release; I hereby glue pamholon for the above requesting olllchl io conduct an Iowa orlminel butory rsaord check with rhe olvlelon orcrtminel Iovenlgetlnht 0. Any edminolhlnorydamwnaemingmethathmaintainedbylhcMrnlybereleased osallowadbylew. Waiver Signature: owa CriminEl IffistoryRecord Check AlkUlLs Pciusamly) As of /027 a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI k c. Iowa Criminal History Record attached, DCI DCT initials DCI -77 (08/25110) Received Time Jan.26. 2016 2'MPM No -6095 Jan.21, 2016 2; 11 PM Div of Criminal Investigation ADDITIONAL IDENTIFIERS CCH RECORD **+ 01 AttRBSTED 19950207 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESSION SCHEDULE I -MARIJUANA TRK#: 014615601 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123�401-3 POSSESS CONTROLLED SUBSTANCE/SCHEDULE I/MARIJUANA TRK#: 014615801 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19950707 PROBATION 1Y 19950707 COMMUNITY SERVICE 100H 19950707 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 No.6268 P. 2/2 IOWA CRIMINAL HISTORY COURT DISPOSITION PENDING DCI 00494587 PAGE 1 OF 1 STATUS UNRNOWN DATE PRINTE0- DCI;004945B7 2016/01/27 NAME: HOPE,MICHAEL GLENN DOS SER RAC HGT WGT EYE HAIR SKN POB 19680306 M W 602 320 BLU BRO FAR IA ADDITIONAL IDENTIFIERS CCH RECORD **+ 01 AttRBSTED 19950207 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESSION SCHEDULE I -MARIJUANA TRK#: 014615601 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123�401-3 POSSESS CONTROLLED SUBSTANCE/SCHEDULE I/MARIJUANA TRK#: 014615801 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19950707 PROBATION 1Y 19950707 COMMUNITY SERVICE 100H 19950707 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 No.6268 P. 2/2 Report.201601111000216 Date of Birth: 31611968 Comments: IOWA DRIVER RECORD REPORT LICENSEE NAME/ADDRESS HOPE, MICHAEL GLENN 2401 HIGHWAY 6 E APT 1003 IOWA CITY IA. 522406706 COUNTY. AKA Name: Page 2 of 4 YD Date of Request: 01/11/2016 LICENSE NUMBER D.O.B. SEX HGT WGT EYES HAIR RACE SOC.SEC DONOR 155AC4503 03/06/1968 M CLASS ORIG. ISSUED ISSUED EXPIRES LIC TYPE D -Chauffeur 09/11/2014 03/06/2019 STATUS RESTRICTIONS ENDORSEMENTS VAL B -Corrective Lenses 3 -Passenger Veh Less Than Sixteen -Passenger Design C.D.L.ISSUED Audit Number: 8437720 C. D. L. STATUS MISCELLANEOUS AND STATE SPECIFIC INFORMATION DRIVING RECORD HISTORY TYPE VIOL/SUS CONV/REI HISTORY ENTRY ACCI 09/21/2015 ACCIDENT Event Type ...........: ACCIDENT Jurisdiction........: IA ACD Code ............: AAA SUSP 09/04/2014 09/08/2014 NON-PAYMENT OF IOWA FINE Event Type..........: SUSPENSION State Code..........: D53 POINTS PTS https://www04.8f7.com/4DACTfON/WebAppTextReporU201601111000216/0 1/21/2016 Report.201601111000216 Page 3 of 4 0 Jurisdiction........: IA ACD ...... ........... : D53 VIOL 05/03/2014 05/29/2014 IMPROPER REGISTRATION Event Typo..........: VIOLA'T'ION Jurisdiction........: CA ACD .................: DLI VIOL 12/15/2013 02/03/2014 FAIL TO OBEY TRAFFIC STGN/STGNAL Event 'Type.,..:.....: VIOLATION State Code .......... M14 Jurisdiction........: IA ACD ...... ....... .... : M14 VIOL 03/28/2013 05/12/2013 SPEED Event Type..........: VIOLATION State Code..........: S92 Suri_ sdi. c Li. on........: IA ACD .................: S92 VIOL 06/17/2012 07/18/2012 SPEED Event Type..........: VIOLATION State Code..........: S92 Jurisdiction........: IA ACD.__ .......... S92 ACCI 03/17/2012 ACCIDENT Event 'Type..........: ACCIDENT Jurisdiction........: IA https://www04.8f7.com/4DACTION/WebAppTextReport/201601111000216/0 1/21/2016 Report.201601111000216 ACD Code ............: AAA END OF REPORT Page 4 of 4 Per your contract with AmencanChecked Inc., you acknowledge that AmericanChecked Inc. utilizes commercially reasonable efforts to ensure complete and accurate reports, however, it does not guarantee the accuracy of any reports. You have also agreed to abide by all FCRA, state, and local laws governing the confidentiality and dissemination of this information. 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