HomeMy WebLinkAbout16-0911 � 1
M
TIC
CITY OF IOWA CITY
410 East Washington Street
l0eva City, Iowa 52 240-1 82 6
(319) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
2. Address (REQUIRED)
IDENTIFICATION NO.
j aq? -
(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)
Lt rfut'e f 3_cc�,tge the "re r�rre" itrfort }afior tti°ift rest tf rrr a`ert�fat ut the ap &s"fcst.00n
3. Contact Information (REQUIRED) Email, 61r1r4
(AII wri
4a. Chauffeur's License expiration date (REQUIRED)
b. Taxicab Business Name (REQUIRED)_/Vi4.Kc0
5. Prior experience in transportation of passengers
/NF /'Cb ,e7
y
r
Va f7lni�n .
communication sent via E
a 3fwZD16
LM
Last
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Cell Phone_
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? !moo
Type of offense Where
When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead GuiltyOtherOther
7. Have you been arrested / charged with any traffic offenses in the last five years? __L � /
M
When
dk/3/QO //
What happened to the charge? (Circle one)
Convicted ismissed Deferred Suspended Plead Guilty Other
Has your driver's license or chauffeur's license been suspended or revoked in the last five years? y e 5
Type of offense Where
G�
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prgyide the name(s)
Np
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIK1'�D
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 VEItICLE DRIVER
Page 2
I hereby rtify that I have i ued to me by the Iowa Dep �m nt of Transportation a valid Chauffeur's license number
Y 2 2 ��� issued on J ?/ori/Lo/6expiring on (J �/3// njl
falsely answer any questions in this application, that this application may pl denied. Il agre making this that
if 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 51 /Ch,h tit 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant_ Date 03t107/14
STATE OF IOWA )
COUNTYOFJOHNSON
and sworn to before me by AO& � i'-� OL S on this _ day of
State
•4**h**k**************Y*k*****hY********kXX******YYY*******k*************************YY*******Y******************************#*k*******h*******k*
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 : 3,� `Z3
aignaturef olice 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.
'i
Signatme of City Clerk or designee
Vi " -
ate
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Clerk(rAXIDRIVB DGEAPPL92014.me,ded DOC
r.:
r_
co
0312D15
oanMar. -2. 2016, 10:10AM
Div of Criminal Inv-_stigation Y DCI 1000 8110 " 5/10
STATE OF IOWA
Criminal History Record Check
Request Form
Tot Iowa D"lon orCrIolual taveatlgados
support oparatioas Bureau, to Floor
113 L 7" Street
Dn M014eo, Iowa 60319
(IM 715 6066
(815)713-6060 Vol,
DCI Account Nntmbcr: gy3�
•�- (trayrl e
Frnmr. �a'ne9 I AXI
4 5ktver.e pr•
0
Y►ane: ;i 319 33F• b14
Fac:. 319 551-53-9
Last Name First N me wso&wr)
Middle Name mw w4wod
Date of Hirthwnda Gender mvAw
SOelai 9"Urily Number
Mule [IFemale
� � I - Y`(' -'0 V
Waiver Information: Mahout a signed waiver from foo subleaf of the request, a complete rrimtorl history record may set
be releasable, per Colo of tour, Chapter 691.1. For sglgpk etimlasl h1stery record IoformaNnn, as allowed by lair, always
obtain a waiver siffletort from the sub set Qj the TtQnL
Waiver Release: n hereby ale MWsolon I r Pbo don rPT +dnt onktal to on" m tows c --*W hawry rmard O"k wld,db DlrWlon otcrimiml
hweelipdon (00o� .vbeNs" hW" div eacaaru&g ati d,al W "fnia�h�W by—/rhe DCI my In Mond u shoed by lew.
Welvergignilture: / �-�
Iowa Crimigal Histan Record Chech ResuLy,thCl ee onryl
As of —•5-zj ('� , a search of the provided name and date of birth revealed:
No Iowa Criminal History Record found with DCI
❑ Iowa Criminal History Record fi awhod, DCl k
DCI inittals•__Iv— v C
DCI -77 (06/25/10) ry
✓v
Received Tlme Mar, 1, 2016 3181'M No. 8637
447410WADOT
SMARTER 4 SIMPLER i LUSTOMEE DRIVEN®. vildva lowadotgov
Office of Driver services
PO Bax 6204 j Des Moines, A 50300-9204
Phone 595-244-5124 1800-432-1121 f Pak- 515-23g-7337
www.iswadol qnv
Certified Abstract of Driving Record
Inquiry Date: 3/1/2016
DL/ID #:
433ZZ8765 (IA)
Customer #:
2169524
Class:
D
Name:
Thomas, Andrew Aaron
Audit #:
9823115
Address:
1505 PLUM ST
Issue Date:
03/01/2016
VAL
CDL Status:
None
CDL Permit Status:
ELG
Expiration Date:
03/30/2023
City/State:
IOWA CITY, IA 522402123
Endorsements:
3
Mailing
1505 PLUM ST
Restrictions:
ComecUve Lenses
Address.
-
Restriction
None
Mailing
IOWA CITY, l7A 522402123
Supplement:
City/State:
Date of Birth:
3/30/1987
Sex:
M
History Information
Convictions
CDL Permit Class: None
CDL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
County
CDL Permit
None
Endorsements:
_
M14 Fail to Obey Traffic Sign/Signal
CDL Permit
None
Restrictions:
'08/28/2013
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Permit Status:
ELG
CDL Cert Status: None
CDL Med Status: None
Citation Date ---_
Conviction Date..--.-
ACD !Explanation
County
9UR
11/0312DII
12/13/2011
_
M14 Fail to Obey Traffic Sign/Signal
Johnson
IA
07/30/2013
'08/28/2013
.;Improper Registration
-Johnson
_
IA
Sanctions
type Effective End _-.. .. ACD Explanation Occurrence IUR IOR
Suspended 11/20/2013 ;12/03/2013 -D53 `Nan -Payment of Iowa Fine IA ;p
Name: Thomas, Andrew Aaron DL/ID: 433ZZ8765
Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Dever 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:
' QtBlple 41p
3/1/2016
a : IOWA
4
Office of Driver Services
Iowa Department of Transportation
Name: Thomas, Andrew Aaron DL/ID: 433ZZ8765