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Home My WebLink About16-118IT .Y OF IOWA CITY 410 East Washington Street Iowa City,iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) (Office Use Only) APPLICATION FOR TAXICAB 1 Mu T OR17FD PEDICAS VEI-hCLE 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 thea lication le 2. Addressil; 1FE 3)4t�7`�✓ooe(an 3. Contact Information (REQUIl"FO) Email: Cell (All written communication sent via email) 4a. Chauffeur's License expiration date ;R!'JjijIPED) b. Taxicab Business Name t.RFOi.t;RED) 1ks 5. Prior experience in transportation of passengers: _ Q !J 5 6. Have you ever been arrested / charged with ary misdemeanors and/or felonies in this State or elsewhere? Type of offensew ?% Y �WhereN When ro a o hat pp�nepd Yo the ar e? (Circle one) J) 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 When 0-4L What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty—O'ttier 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years r' Where ,`(et When _- ------ ___.._.�-�_S> W "� ......_.�—_......__U�_o2. J I cA- 9. Have yo,Iur� ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the mi'me(s)' 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 avallahle upor'�equest). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) APP6 CAi'IOM FOR i AXICAS VEHICLE O IVER Paue 2 I hereby certify that I have issued to me by the Iowa Dep d:ent_of Transportatio, valid Chauffeur's license number 17 1 �G i37� I issued an D Zo expiring on 2a j c� 2- I understand that if 1 falsely answer any questions in this application, that this ip li at may be denied. a ree that ir, 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 provision s�jtic 5, Chapter 7, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant_61r � �'r TM_— Date S 3` l0 **x*i***s,!k».-**-AY *t*x**Y. s*#}#3}'h*hk'*&h'XX3*t*+*******i******Ji***' **r*.u'**#_h%k*#th+:.****,i** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ,__L16 iytT s on this 3 ✓o(µ day of o.. NADIA SOJKA ber 779849 Notar i and for the State of Io--�^�a ' My CorIlmi�s LonExpires 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 orwelfare of resi- dents of the City of Iowa City (Tide 5, Chapter 2, City Code). Expiration date of Chauffeur's � ® Z 1 2 % Z �L� �igrnaiu€e oT route f-irrer or oes.gr ee V uat . 4 AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A T6iXICA IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. S{gn re o> City Clerk or designee D to Office Use Only Approved application DCl report State certified driving record Website update t,^ FApr, 1. R16„ 1,48PNO[ErOiv of Criminal Inves_tlgation No, 1355 F. 5;!7 O S/06/2Og5 11:L_ .146E . .,,,•2/003 I /0 - wairer he relea! obtain a STATE OF 1()ViA ,' Crik"incl Rktory Record Cherit ' ¢ ) RefitEt.o )rqPrf' I6R'a Division of criminal Inec.utigatiml Support ()peraiions Bureau, 1" F4ogr 215 L. 7"' Street Des Moines, 101Ye 50,319 (515)725-6066 (51S)'726-60801hax Still& an Aowa Criminal liislol Record the (mandaio 9 First P Com/ DO Account Number _ Le� u Zr� Frum: Cif ' Uf Iok'a E,'iE flityClerlc'sUffice -' 410 F;. 1?'ash ton u'treet C timrc: 319.356-5Q4j Far: 319-356.5497 rrttafiott: Without a signed w'Alver from thesublect of the iequest Y complete a iminal history re.rord may no( per Code of town, Chapter 692.,2, ror complete crim{Dal history record information, as allowed by tau-; alu-ays rSi nalm'efro7athesubjeeloflherequesl. ncncuy_gUSAcmntsion for criminal history da[aconce Waive!• hisiup�'(CGnnl'c1RT6"wiiL [ne Iowa Ctianitlad Histo, 1 Re rco dFIS eclt I�e�laits — As of ( ��T— a search of 111e provided name and date Of U11, revealedcl No lots Critninal Ni -3100' Record found with DCl Iotita L'rinlinal Histol)' Jtecord attached, nc] a `t7QGL1 j ((( ��• DC -J 1131t1a1.s.-- DCI -77 (09/25/10) Received Time Apr. 6. 2016 11.12AM No. 1223 1 � (u!'ilgfii�jly) x- Q - w :,rl Apr. 1. 2016 1:4o" NM Div of Crirrinal [ovesfigati0o No, 1335 F. 6/7 DCI:00472643 NAME: WINTERS,CHAD DAVID DOB SEX RAC 19751021 M W ADDITIONAL IDENTIFIERS SC L ELB TAT R SHLD IOWA CRIMINAL HISTORY DCI 00472643 FELONY CONVICTION PAGE 1 OF 2 DATE PRINTED - 2016/04/07 HOT WGT EYE. HAIR SKN POB 60'? 190 BLU BRO F'AR 1A CCH RECORD *•- 01 ARRESTED 19931217 AGENCY: IA0790100 GRINNELL PD CHARGE NO- 01 IA STATUTE IA321-561 DRIVE WHILE BARRED TRK#: 000313301 COURT DISPOSITION AGENCY: IA079015J POWESHIEK CO DIST COURT COUNT NO- O1 IA STATUTE: IA321-561 DRIVE WHILE BARRED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 000313301 SENTENCE PLEAD GUILTY FINE $500 02 ARRESTED 19950514 AGENCY: IA0790000 POWESHIEK CO SO CHARGE NO- 01 IA STATUTE IA908-1 PROBATION VIOLATION TRK#: 018301101 COURT DISPOSITION AGENCY: IA079015J POWESHIEK CO DIST COURT COUNT NO- 01 IA STATUTE: IA900-1 PROBATION VIOLATION CHARGE CLASS: STATUS UNKNOWN TRK#: 018301101 SENTENCE JAIL 60D COURT COSTS 03 ARRESTED 19970827 AGENCY: IA0750100 GRINNELL PD CHARGE NO- 04 IA STATUTE IA720-4 TAMPERING W/WITNESS TRK#: 017593104 COURT DISPOSITION AGENCY: IA079015J POW£SHIBK CO DIST COURT COUNT NO- 04 TA STATUTE: IA720-4 TAMPERING W/WITNESS CHARGE CLASS: MISDEMEANOR CONVICTION DISP EFF DAT 19940126 19940126 DISP EFF DAT 19951215 19951215 ' Lli .w' Apr. 7. N 15 1:48PN Div of ( r i m i n a I investigation DCI 00472643 PAGE 2 OF 2 TRK#: 017593104 SENTENCE DISP EFF DAT PLEAD GUILTY 19900216 PINE $600 /99802/6 04 ARRESTED 19970029 AGENCY: IA0500000 JASPER CO SO CHARGE NO- 01 IA STATUTE IA709-4 SEXUAL ABUSE 3RD DEGREE TRK#: 016947901 COURT DISPOSITION AGENCY: IAD50015J JASPER CO DIST COURT COUNT NO- 01 IA STATUTE: IA709-4(2)(C)(, SEXUAL ABUSE 3RD DEGREE CHARGE CLASS: FELONY CONVICTION TRK#: 016947901 SENTENCE DISP EFF DAT FINE $500 19980223 COURT COSTS 19900223 SUSPENDED PRISON SOY 19980223 PROBATION 3Y 19980223 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RS:LRASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISH$D, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OP YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION �1 No. ?35; P, 7/7 c r%t r Iowa Department of Transportation OMilr of [V*w Semi= (tdi Free) &W-53211*11 li44 W*) PO am t2lm,Coes k tx:tes, jA wxit,0234 515 244-3124 AX- 51 &233.193 t Certified Abstract of Driving Record Inquiry Date: 4/5/2016 DL/ID #: Name: Winters, Chad David Class: Address: 4274 WOODLAND Audit #: VAL HILLS DR CDL Status: VAL 10/21/2022 Issue Date: City/State: BROOKLYN, IA Expiration Date: Interstate 522119586 CDL Med Status: Certified Corrective Lenses Endorsements: Mailing Address: 4274 WOODLAND Restrictions: HILLS DR M Date of Birth: Mailing BROOKLYN, IA Sex: City/State: 522119586 CDL Medical Examiner's Certificate 174CC1324 (IA) Customer #: 1423633 A ID Status: None 8513179 DL Status: VAL 10/08/2D14 CDL Status: VAL 10/21/2022 CDL Cert Status: Non -Excepted 714 630-3636 Medical Certificate Restriction 1 Interstate L CDL Med Status: Certified Corrective Lenses Restriction None Supplement: 10/21/1975 M Certificate Specifics Explanations Medical Examiner First Name Richard Medical Examiner Middle Name E Medical Examiner Last Name Hughes Medical Examiner License Number C35297 Medical Examiner National Registry Number 5904551285 Medical Examiner Jurisdiction CA Medical Examiner Phone 714 630-3636 Medical Certificate Restriction 1 Wearing corrective lenses Medical Certificate Issued Date 02/23/2015 ^' Medical Certificate Expiration Date 01/23/2017 Date Added to CDLIS Driving Record 03/25/2015 N -� History Information Convictions Citation Date Conviction Date ACD Explanation cn ]UR Citation Date Conviction Date ACD Explanation County ]UR 06/07/2011 07/11/2011 F66 Unsafe condition of FL vehicle (no specified com anent 10/25/2015 11/05/2015 F04 Seat Belt Violation Benton IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 1 112/31/2007 1413606 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 08/29/2011 10/13/2011 D51 Non -Payment of FL Child Support Suspended 06/19/2012 07/16/2012 D51 Non -Payment of IA IA Child Su ort Name: Winters, Chad David DL/ID: 174CC1324 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: 4/5/2016 Office of Driver Services Iowa Department of Transporation t :a c� Name: Winters, Chad David DL/ID: 174CC1324 .rd