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Home My WebLink About16-124.�r 1 CITY OF IOWA CITY 41 D EasL Washington Slrccl luwa City, lowz 52240-1826 (3191356-5040 (3 191 356-5497 FAX 9, Name (REQUIRLD) 2. Address (REQUIRED IDENTIFICATION N0. — Z— Li I (Office UseOnly) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m, Monday — Friday) Faiture to camp/ete the 'required" information will result in denial of the application 3_ Contact Information (REQUIRED) Email: Cell Phone3j? i-3�oi� (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) ✓G' c- 2 b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers, -------------------- Z Have you ever been arrested I charged with any misdemeanors and/or felonies in this State '67 elsevSfti rev i .." Type of offense Where blhen z P2 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedead Gull Other Have you been arrested / charged with any traffic offenses in the last five years? 5 191"k, arte^ T1 ekc-76 Tyne of offense Where What happened to the cha-ge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guiltv bther Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ Tyne of offense Where 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 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 I hereby certify that I have sued to me by the Iowa De artme t of Transportation vali Chauffeur's license number sued on expiring on j6z, z�.. I understand that ii I falsely ans exec+�uestions in this application, that this applicati n may be denied. I gree 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, it authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title Chapter the City Cede_ (Needs to be signed in front of a Notary Public) Signature of Applicant- ��-�� Date STATF OF IOWA j COUNTY OF JOHNSON ) S=ed an1.�d worn to before me by Ji �n i �`, /1 %F'(Fi on this /ta� day of /_ KELLIE K. 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 thatthe 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 Z Z J. Signature of Police C ief 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. Signatu of City Clerk or designee 1 04 -DI %A#.1}+*%xR*%k}%k*S%k#+�kHHkxkA*k}A kAak xxk}Aak#*%T1%%iTh%.i%%k%nMx%x*xwxxa.xxxxxxxxxxxxxxx#xxxAx'AkA xhkAk*hlk%i.l*Fk****xxxxixxxxxxxxxxxxxtxaAk#A• Office Use Only c'7 Approved application DCI report — State certified driving record U I Website update 01uw AxioniveaneenPPMC14aickilxdoac 03120 3 Uea. 1. LV1ITJHUI Uiv 0 7 Lt;T,iaaI IOv PSsi23l!b0 N26L, i', 1/3 Flu rno�., ,y or Iowa. �.qy glErh rJllloc 3lA 366EO U7 �g /0312O1G lo_2G' M33a P.PD21002 STATE OF IOWA A"W' Crinlinai History Rk:eord Check Request Form To: lows Dlvistan of C:r[in mol fuvcstiggfion Support Operations Bureau, I" Floor 215 C. 7' street Des Moines, Iowa 50319 (515)725-6066 (515) 725-6090 Fay f �e r � Date of 1311-th has"darr DC) Account Number: Ll 3 - F "_(ii ayprlcIbic) — fi: nl CIC of IOUA City Clly Clerids U(Gtr. 4I0 E, Washhl lou uirrdt 10ua Ciiy. IA 52:40 Phone: 319-356-304I Fax: 319-3SC-5497 -- -- I1°`011`001._ SOpAl.S'C/CLLI'1*�NIILr �/Cr'/Icer/onllneiWco `- � �i1181C ❑�''Ct1131e ! t�i / � (1% J (G'' l3�aivel'Injor�natiolt: Without a signed waiver from the ru6ject of the request; a complete criminal history record vnay not he releasable, per Code orfowa, Chapter 692.2. roc co_Q criminal history recard Informu(ien, as allowed by lam, always obdafn a waiver si ualw'eham the suhlectofthe remrrsr Waiver l?eka ti: I hcrcby si, remits w for [hit above tege;sdng efticiot to ci,Ajcr as lows iminal Naory recard Nick lvi h he D visors MCrimnlnl lnvreligetioa(ACII, Any ulmk,of LCsroq Ealyconcuningum Natis menr[ain by Oee LCl may be relmse�.as olln,Ycd by falx. WaiverSrgnalfrre: Iowa Criminal Histo r r Records Checll Results vl IC(J use billy) As of _ 1Z3 , a search of (he provided name and data of hitlh revealed: ❑ No lou'a Criutinat History Record fowid wish I)CI �dL 101v8 Criminal History Record attached, DCI DCl .inihals-�_ c, -' DCI -77 (08/25110) --� — -- Received Tim¢ 0eC, 1 2 0 i 5 9:15AM Na, 3961 Uec. /. 2@19 9�4JAN Uiv Lt l•rlminII InvestIgatian No. 1665 Iij IOWA CRIMINAL HISTORY DCI 00169110 MISDEMEANOR CONVICTIONS ONLY PACE 1 OF 2 DATE PRINTED - 2015/12/07 ACX :00105118 NAMC': MSIER,MARK ALAN MBTRR,MARK ALLEN DOD SEX RAC HOT WGT EYE HAIR SXH POE 19540910 M W 511 200 ARO BRO Mn IA ADDITIONAL IDENTIFIERS GLASSES SC L MEE SC R KNEE CCH RECORD x+a 01 ARRESTED 19730306 AGENCY: TMEM00 DAVENPORT PD CHARGE 00- 01 DELIVSR MARIJUANA TRKN; L07626701 COURT DISPOSITION AGENCY: IA082015J SCOTT CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(3) CONTROLLED SUBSTANCE / POSSESSION/MARIJUANA - 1993 CHARGE CLASS, MISDEMEANOR CONVICTION TRK#: 1,07626701 SENTENCE DISP EFF DAT SYM9NOED JAIL 6N 19731030 PROEXTTON 19731030 02 ARRESTED 19910507 AGENCY: IAD520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRM L07626BOI COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 TA STATUTE; IA321J.2 OPER VEH WE INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L07626802 SENTENCE DIED EPP DAT JAIL 2D 19910627 FINE $500 19910627 CREDIT W/TIME SERVED 7H 19910627 03 ARRESTED 19951111 AGENCY: TA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRK#: 022560101 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT De:. 7. 2015 9:43AM Div of Criminal Investigation No, 2645 P. 9/3 COUNT NO- 01 IA STATUTE: IA321J.2 (Fe) OPER VEH WH INT 1010-) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK{f: 0225607.01 SENTENCE JAIL 7D FINE $750 DCI 00169116 PAGE 2 OF 2 D -SP EFF DAT 19560221 19960221 AN ARREST WITWOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMIANIIX INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAY; ENFORCEMENT AGENCIES 9Y THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON ,-NFOPKATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION �1 �- wvJwowadat nov SAV dTtR I SINT1, F, I CUtTOVF (IRI' £Vn.. Office of Driver Services PO Bor 9204 Des MofheS. IA 50306-92¢4 Phone:' 6.15-244-9124 I60C-532-1121 I Far: 515.235-IfW OAq dvtadot.9cy Inquiry Data: 12/3/2D15 Customer 4; 1683236 Name: Meier, Mark Allan Address: 1031 290TH 51 City/State: AI ALISSA, IA 527209641 Mailing PO BOX 132 Address: Mailing ATALISSA, IA 527200132 City/State: Date of Birth: 9/18/1954 Sex: M Convictions Certified Abstract of Driving Record DL/ID ri: 075AA0689 (IA) CDL Permit Class: None Class: D LDL Permit Issue None IA )9/13(2014 Date: IA Audit 9; 8410628 CDL Permit None Expiration Date: Issue Date: 09/03/2014 CDL Permit None Endorsements: Expiration Date: 09/18/2020 CDL Permit None Restrictions: Endorsements: 3 ID Status: None Restrictions: NONE OL Status: VAL Restriction None CDL Status: None Supplement: CD1 Permit Status: ELG CDL Cert Status: None CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation County JUR 10/07/2012 11/05/2012 S92 Speed Johnson lA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. lccident Date Case Number 3DR 11/18/2009 500760 IA 13/12/2013 730061 IA )9/13(2014 816583 IA Name: Meier, Mark Allan DL/ID: 07SAA0689 Pursuant to Iowa Code §321.10, T, Kim Snook, Director of ice 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: Wall by ♦�;•• �' 12/3/2015 %IOWA l% D. 0. T •• 4.....4 Office of Driver Services 41: Iowa Department of Transportation Name: Meier, Mark Allan DL/ID: 075AA0689