HomeMy WebLinkAbout16-083j r t
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (IRE0,UIREU)
2. Address (RI iiiiQLJI6 I.. l.))
IDENTIFICATION NO
14,)-ag3
(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)
:I OOP r d�aa r r rrb
„ar rrr�� Paa a2to , d ( p 'a�a!ad ^ra0�i:roa�r�aro�uYar��a�r aw�4't0'r-�rw�,lad: rr�y i��iPW-�rr� uB u�Y"�Pu"�ri�� �s2PuPui°�tdi��im7
3. Contact Information (PEQUlRliiiiD)
4a. Chauffeur's License expiration date (REQL.fl I-.[))
b. Taxicab Business Name ([: lI QUll'iliiiiD)
5. Prior experience in transportation of passengers: _
R.
email)
Phone: 31L� TILI /nSIZ
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
7
What happened to the charge? (Circle one)
I In71111C, GOtrl
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense Where
lea ( 20)X Cof-fl)1�,��a.
When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended ead Gu' Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provldf�the FL
me(s) "
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIEU)
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIf W
4.;.
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 hereb certify that I have issued to me by the Iowa De rtme t of Transportation a val d Ch uffeur's license number
�� 7 (% iD issued on .2 0 1 expiring on '2-11 y z I understand that if I
falsely answer any questions in thisapplication, that this app ication may be denied. I agree that in making this application, I
consent to allow agents or emplo le e: f the City of Iowa City Iowa, in their discretion, to examine any and all records and
documents relating to this applic Io not urth a ee that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions e apt,r 2, of he City Code. (Needs to be signVinontof a Notary Public)
Signature ofApplicantDate �
*****k*****#**********#*************************k*******x*******xx**********************************k**x*k***kk********xx****x**************#***
STATE OF IOWA )
COUNTY OF JOHNSON 1
S,gbscribed pnd sworn to before me by ��C?tC T4Y- r on this �� day of
sw
.e P ,-e V 1114440
Public in and for the
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 1
} — 1&12.0/:6
Signature grPop e Chief or designee Date
v
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.
� �A/ -/cz�_
Signa e of City Clerk or desig e
Date
Office Use Only
._
Approved application c
DCI report
State certified driving record
Website update A
Clerk Tr IBRIVBADGEAPPL92014.m.,ded.000 0312015
Iowa Department of 'Transportation
C81 3Office of Dll'W 3emces (Toll Free) 80{F532-1121
�F to Box 9204, Des Manes, W 59--4069204 5155-244-9124
" FAK 515239-107
Sanctions
Type
Certified Abstract of Driving Record
End
Inquiry Date:
4/18/2016
DL/ID #:
407AFS706(IA)
Customer #:
1533865
Name:
Dorr, Scott Edward
Class:
D
ID Status:
EXP
Address:
1749 PARK RIDGE
Audit #:
8940172
DL Status:
VAL
DR
Child Su ort
Suspended
Issue Date:
03/20/2015
CDL Status:
None
City/State:
CORALVILLE, IA
Expiration Date:
02/18/2020
CDL Cert Status:
None
Child Su ort
522412741
Suspended
03/26/2014
09/14/2014
D51
Non -Payment of
Endorsements:
3
CDL Med Status:
None
Mailing Address:
1749 PARK RIDGE
Restrictions:
Corrective Lenses
Restriction
None
05/18/2016
DR
D51
Non -Payment of
Supplement:
IA
Date of Birth:
2/18/1963
Child Su ort
Mailing
CORALVILLE, IA
Sex:
M
City/State:
522412741
History Information
Sanctions
Type
Effective
End
ACD
Explanation
Occurrence
JUR
JUR
Suspended
05/25/2010
08/16/2010
D51
Non -Payment of
IA
IA
Child Su ort
Suspended
05/25/2011
05/27/2013
D51
Non -Payment of
IA
IA
Child Su ort
Suspended
03/26/2014
09/14/2014
D51
Non -Payment of
IA
IA
Child Support
Suspended
05/18/2016
INDEFINITE
D51
Non -Payment of
IA
IA
Child Su ort
Name: Derr, Scott Edward DL/ID: 407AF8706
Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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:
Ki1ec�[f,'11w 4/18/2016
'W r
IOWA
O
D. 0. T.
iy Office of Driver Services
Iowa Department of Transporation
Name: Dorr, Scott Edward DL/ID; 407AF8706
o,Apr. 12 2016; 4:15PM, cetDiv of Criminal Investigation (aax)3tssseNo. 1658 P. 1/22002
STATE OF IOWA
,, :�Ib°• •`fir' p.,•„ YCriminal History Record Check
.1
Form
To; tows Division Of Criminal lnvcstlgetion
Support Operations Ehroau, I" Floor
215 C. ?"Street
Dcs Moines, lorva 50319
(515) 725.6066
(515)'725.6080 Fax
cc
DCT Account Number; 9967-F
(Ir9ppriv ma)
Froml _ Yellow Cab 0flowo City
P.O. Box 428
Icwn City, IA. 52244
(319) 338.9777
Phonet
Fax, (319) 339.7302
21
17kale ❑FemAle FO 7 -35
rvarveY [nformadlon, Without a slgnod wolver from the subject of rho request, a complgta V111111111101 history record may not
be releasable, per Code or lows, Chapter 692,2,. For com le criminal history-ramrd In jormatloh, as Olin
wed by laver alwaysin o wAlvar signature from the aubleet of the reauecr_
Walyerj?'ll"SM 1 herebyglve Pen,lhllen far,he above
Imctuga;rentpC9• Myettminolhlrmry dole eancomingMe)
Waiver signature,
el hl:,arYnoord cheek wills IN Dlvislon of Criminal
a1 ellowoa by law,
(DCl oto only)
As of ��� l l� a search of the pro vtded name and date of birth revealed;
No fowa Criminal History Record found with DC1
Iowa Criminal History Record attached, DCT # ; r '
DCI initials 3
.L.1
DC1.77 (08/25110) ~
Received Time Apr, It 2016 2:26PM No -2087
Apr.12. 2016 4: 15 PM D l v of Criminal Investigation
IOWA CRIMINAL HISTORY DCI 00456730
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED-
DCI:00456730 2016/04/12
NAME: DORR,SCOOTER
DORR,SCOTT EDWARD
SCOOTER
DOE SEX RAC HOT WGT EYE HAIR SKN POB
19630219 M W 600 185 BLU SRO MED � GA
ADDITIONAL IDENTIFIERS
SC L WRIST
CCH RECORD www
01 ARRESTED 19930320
AGENCY: IAOS20200
IOWA CITY PD
CHARGE NO- 01
IA STATUTE IA236-2A
ASSAULT W/INJURY
TRK#: 005989601
COURT DISPOSITION
AGENCY; IA052015J
JOHNSON CO DIST COURT
COUNT NO- 01
IA STATUTE; IA236-2A
PLED TO SIMPLE ASSAULT
CHARGE CLASS; MISDEMEANOR CONVICTION
TRK#: 005989601
SENTENCE
DISP EFF DAT
FINE
$50
19930922
02 ARRESTED 19950210
AGENCY: TADS20100
CORALVILLE PD
CHARGE NO- 01
IA STATUTE IA321J-2
OWI
TRK#: 014616901
COURT DISPOSITION
AGENCY: IA052015J
JOHNSON CO DIST COURT
COUNT NO- 01
IA STATUTE; IA321J-2
OWI
CHARGE CLASS; MISDEMEANOR CONVICTION
TRK#: 014616901
SENTENCE
DISP EFF DAT
JAIL 6D 19950217
PAY SURCHG
FINE $500 19950217
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. 1658 P. 2/2