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Home My WebLink About16-128J � l r • Mlw®rC1l CITY OF IOWA CITY 410 East Washington Strecl Iowa City. Iowa 52240- 1826 (3 19) 356-5040 (3 19) 356-5497 FAX IDENTIFICATION NO. I:kp (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 First Middle Last 1. Name (REQUIRED) palz (1) l ir, t C `-D ic, O ' c,i 2. Address (REQUIRED) y `1 'L 1 (,. ,.,} `f S r ,'h, f I S z7- r —7 F 3. Contact Information (REQUIRED) Email: 4621 �tik4,,r,e q4i`1,5 d, C" Cell Phone: ( 3L9 yrS -97zi (All written b6mmuni tion sent via email) 4a. Driver's License expiration date (REQUIRED) _�Z —2 3 / 2-01 � b. Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? X"") Type of offense Where When 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? Type of offense Where When= - _Ci T - -142-0,1- >rLcri� What happened to the charge? (Circle one)°t'+°°" Convicted Dismissed Deferred Suspended eleacl Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4(%j Type of offense Where When 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) 0712016 T— yer 5pcc,s 5/az Zd c6c7, TiAfF•C S,9.„( Tawe TG wad 6/!ZO I N �Gw0. 812, Z- APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number l U9 �r z -19Z S issued on Z ls'_o` expiring on S 4I i Z, e . I understand that if I falsely answer any questions in this application, that this applicdtion 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by Ql�w X Cry c aJr0 � J_ in and for on this day of 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 Driver's Iic se gnature of Police Chief or designee Zr Z.3- Z0 [I 1// zl ►4 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. Sign re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ;7/1-/i,� Date Clerklr ICRNBADGEAPPL92014amended.DOC 0712016 Iowa Department of Transportation CAO Once of Depfer serywces (Dif Free) 80G,632 1121 F0 Gm 9204, Des Manes, IA 563069204 515-244-8124 fAX_ 315-239-1837 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 6/28/2016 DL/ID #: 149AC4925(IA) Customer #: 5270935 Name: Drogos, David Eric Class: C ID Status: None Address: 4421 E COURT ST Audit #: 7484054 DL Status: VAL Improper Registration Johnson Issue Date: 10/30/2013 CDL Status: None City/State: IOWA CIN, IA Expiration Date: 02/23/2017 CDL Cert Status: None Seed 522459306 IA 11/01/2015 12/31/2015 S92 Speed Johnson Endorsements: L CDL Med Status: None Mailing Address: 4421 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 2/23/1987 Mailing IOWA CITY, IA Sex: M City/State: 522459306 History Information Convictions Citation Date Conviction Date ACD Explanation County IUR 09/29/2008 10/21/2008 S92 Seed Johnson IA 08/27/2012 09/27/2012 S92 Seed Johnson IA 06/05/2013 07/09/2013 Improper Registration Johnson IA 09/30/2013 01/30/2014 M14 Fail to Obey Traffic Si n/Si nal Johnson IA 07/27/2015 09/16/2015 IS92 Seed Johnson IA 11/01/2015 12/31/2015 S92 Speed Johnson IA Name: Drogos, David Eric DL/ID: 149AC4925 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 1 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: 6/28/2016 IOWA`: . ..,- Office of Driver Services .wee. Iowa Department of Transporation Name: Drogos, David Eric DL/ID; 149AC4925 FrJu1• 5• 20 16 , 2: 12 PMC, Qr 01v of Crlminal lnveshgaficn o N3150/2016 12 fNo. 159268(P. 1/1,1002 FAX Criminal History Reca€ d Check Requesk Form UCI A.eeo6tt11 Nnnll)e( GfnpplicahL) - "f o: Inwa 13ividion of Urnina€ Invegtigal16tl From: City, of iuwe C€3V Support opeWions Hurcau, P Floor City C. let Offlce✓ -�- 215 E. 7" street q14 E, Wasliinglon Street Des Moines, Iowa 50319 _. ��_r�g2V.-6l3G�---. _,,_ �"ve+r•CiEy;-ift-1'rb�4(✓--- —__— (515) 72'5-60Ao Fax -- ----�" V `-----'-.--- Phone: 319-356-5041 Fax: 319-336-5497 I am. renucS inu an Town Criminal T-Tislnm Rnem-d Chock nn• I ast Strome (Inanaato y) First N2)ne (mandatory) _ -- Middle ]Name (aconuumded) — rG o5 �Avl��tC- Date of Birth mandawry) Gender (mandato • Social Securit), Number (recon,rnu,ded GZ Z 3 ! �1tBale LIi CnralC 331 - 8 W - 693 Waiver hiforEnation: Without a signed waiver from the subject of file request, a complete criminal history record may not. be releasable, per Code of Iowa, Chapter 692.2. For comnlete criminal history record information, as allowed by law, always ob(ain a waiver signature from thes ib est of the pe ue5t. Qlver a EILYet 1 larcbysive permission for the abat,c requesting official to conduct an lawn criumml history record check with the Civision of Criminal Invenigotion (nCq. Any criminal hislety dmo conceming me that is maintained by the ACI may be released as allowed by law. WaiverSignature;____` Iowa Criminal History Record Check Results � ncln,eonly) As of =�$�,�, a search of the pigvided name and date of birth revealed; No Iowa Cl-invnal141story Record found Nvith DO ' CD t Q Iowa Criminal l-Iistory Record attached, l7CS J DC1 initials .-------- llCl-77 (09/25/)0) ---— ___-u---------------�-- Received Time Jun, 30. 2016 12;41PM No. 1369