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Home My WebLink About16-056A% CITY OF IOWA CITY 410 East Washington Strcet Iowa City, Iowa 52240.1826 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. Lf — C7 ,�-I o (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 1. Name (REQUIRED) 2. Address (REQUIRED) `31-1 5 4411-1 2 -z - 3. Z3. Contact Information (REQUIRED) Email: 1�UCt (All writte lM1LtQ �oVZZ K,V-er5. communication sent via emai 4a. Chauffeur's License expiration date (REQUIRED) 5- 6"4 1 b. Taxicab Business Name (REQUIRED) 1 UI`Cit, r <rjlS 5. Prior experience in transportation of passengers: IMck i < U 5L7 �t�clg0c)-ctI s-7 6. Have you ever been arrested /charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense p rc-e-FII j (o�d�c F Where �bLL) L,Cf h 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? e S Type of offense rr Where 'Falk ro 0\0 P, c�C, When 1`e� - 20C) What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPlead Guil Other/ t 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When :s 9. Have 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 RE�tIEW 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 Department of Transportation a valid Chu yy�r's license number T 3 `1 Cc- 5 i � � issued on 3- -� 49 expiring on �t 9 . - riderstand that if 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 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 itle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature ofApplica — — Date 3`iG- i 6 STATE OF IOWA ) COUNTY OF JOHNSON 1 subscribed and sworn to before me by (`J ,V\\r� , ow on this ) S �� oday of yrch ar� in and for the State -61' Iowa � 13jr� 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 to of C ur's license T Sign ture f Poli Chief or designee S'S" ate/ 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. Sign> turtrof City Clerk ordesignee Dille / Office Use Only Approved application rn DCI report State certified driving record Website update ClerkTA IDRIv6AOGP PPL92a15amended.DOC 03/2015 aa, ar�_ 8.- 2016 ::Opm Div of Criminal Investigation DCI IONo, 9273 P, I/2 STATE OF IOWA " Criminal History Record Cbeck t Request Form: To: 10w■blv4lan ofCrbml■allovedipdon Support Operalaae bureau, 1" Floor 215 L 76 street Des Maloee, roles/ 50319 (f 15) 729.6066 (SIS) 71560!0 FLa f Am rat, I,raYtmv vh [nese (`eiminsl {Iis,r..0 m...:...1 nR..._I. __: d•"' ,n4 �. �i DCI Amount Number; 4313J'�" (ireppikehle) From, _ MA'fW TAXI 114 5ke.Vt, S Qr. rba■e: ,t 314 338 - Fat:.. 311 ssl' est Name (amL Fist Name i Mid N me As of a search of the provided name and date of birth revealed: a tfateolH(lorfh a.doY Gead r 9ocia18000ri Number ❑ No Iowa Criminal History Record found with DCI Ll p -11--773) J Mde ❑Female Iowa Criminal History Record attached, DCI q a -73 r WaiverT)1/brm&401 Wahout ■ rlpoed waiver from the subject tree request, a complete crlmleal Watery record torymot be rdenobte, per Code of 10W$=12.1. For X14 crlmhN Ablary record fofarm■ebo, as allowed by hes, always btala wahcr a re from of the r uat 'x-60.1 WufverRdea+e:tnaatypraemewlonfor the maomuos wm tnreeilq{fpn (uCI). Aq' 4lmtael h4wer ddh i me u■1 a DO my he �de6ackwW�d�enlwrmefCYinlnl owed lo, low. Waiver Sign E DC1 Initials- -*c7 _ _ (rlCl,aa only) As of a search of the provided name and date of birth revealed: a ❑ No Iowa Criminal History Record found with DCI c J t_ Iowa Criminal History Record attached, DCI q a -73 r 'x-60.1 E DC1 Initials- -*c7 Received 7ime Mar. 1. 2016 11:04AM No. 9066 Mar. 0. 2016 3:09FM Div of Criminal lnvestigafion IOWA CRIMINAL HISTORY DCI 00882738 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- PCI:00882738 2016/03/00 NAME: BROWN,NATHAN RANDALL DOB SEX RAC HGT WGT EYE HAIR SKN POB 19800306 M W 603 280 BLU BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE; Y SC R KNEE TAT CHEST TAT L ARM TAT R ARM TAT UL ARM CCH RECORD *** 01 ARRESTED 20091115 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 SA STATUTE IA700.2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY ' TRK#: IAQQ06101 COURT DYSPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA723.40) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR COURT CASE ID: 06521 SRCROB9015 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA0006IGI RESTITUTION SENTENCE DISP EFF DAT FINE $100 20100409 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 DCX, 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 SUB,7ECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.92}3 F. 2/2 .-UVVADOT ..rte € cv� lim io adot gav �rt+�RT� lniFtE�:1 Cii�:§�tF.':: U�r'�:'.;. Office of Dfivet Services PO BOX 9204 'OAS M01neS, 1A 571&3-9204 Phone :515-244:-91241SCD-E32-112"1 IPail: 515-239-1 S37 u xrr_i>wadot.gc v Inquiry Date: Customer Name: Address: Certified Abstract of Driving Record 3/9/2016 DL/ID #: 239CC5786 (IA) CDL Permit Class: None 2159919 Class: B Brown, Nathan Randall Audit #: 3175 HIGHWAY 22 LOT Issue Date: 22 City/State: RIVERSIDE, IA Convictions 8917424 03/12/2015 Expiration 03/06/2016 Date: Endorsements: NONE Restrictions: NONE Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit 523279601 Mailing 3175 HIGHWAY 22 LOT Address: 22 Mailing RIVERSIDE, IA City/State: 523279601 Date of 3/6/1980 Birth: None Sex: M Convictions 8917424 03/12/2015 Expiration 03/06/2016 Date: Endorsements: NONE Restrictions: NONE Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation COL Permit None Endorsements: 01/08/2015 CDL Permit None Restrictions: IA ID Status: None DL Status: CDL Status: CDL Permit Status: CDL Cert Status: VAL VAL ELG Excepted Interstate CDL Med Status: None CitaVon Date Conviction Date ACCs Explanation County 09/11/2014 01/08/2015 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 .1ttR 10/04/2013 ...760447., � IA c� Name: Brown, Nathan Randall DL/ID: 239CC5786 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa- Departrllent f , hereby certify that I am the custodian of the records held by the Office of Driver Service s, that fhls is a-tsueTans rate copy of oTransportationdo an official record currently in the custody of said office, and that I have been authorized by the DirectorQf.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 occ this date: P p document, at Ankeny, Iowa >'oe.E..... ®V102,101,