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Home My WebLink About16-133) l 1 7r, � �I II1�9tp CITY OF IOWA CITY 410 East wash!nglon Sl reel Iowa City. Iowa 52240-1825 (319) 356-5040 (3 19) 355-5497 FAX 1. Name (REQUIRED) . IDENTIFICATION NO lie_ �; (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 T 2. Address (REQUIRED) d 3 Z� 5T 5 c 3. Contact Information (REQUIRED) Email: a< 54, F73 1Ia�C„R Z(riqy�IIAZtr• Cell Phone) -5iii)-5 �AII written communic6tion sent via email) email) 4a. Driver's License expiration date (REQUIRED) _ b. Taxicab Business Name (REQUIRED) _ rJ um 5. Prior experience in transportation of passengers: Q Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _ Type of offense 6�0S .rte 4xcci Y �' ^j, Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended uiltyOther Have you been,arrested / charged with any traffic offenses in the last five years? 1ti0 Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8, Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where WIne > 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) c 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I herebycertify{ that I have issued to me by the Iowa Department of Transportation valid Driver's license number 30i N it 5-1a issued on q. expiring on ' Q it V . I understand that if I falsely answer any questions in this application, that this applic tion 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. 0& 0 �t � � � � Date__:7,b � 1 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by l� C n� g 1LA)U Zoil1 2"(Lg 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 of Iowa City (Title 5, Chapter 2, City Code). VoDr'er's license -21 Zor designee I 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. �4�IF�L'IZ-2 r"r� -'f Ham! 7r�t? Signature of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record Website update aerkTA 10RIV ADGEAPPL92014am ded.00c 07/2016 �ul.[7. [oln i�Iorvi Dlv o] �rlminaI Investigation Fl� No, 8884 F. 5 07/20/201COe:ru 4aa- r.tl02/002 STATE OF IOWACJriminal HistOry Record Check - \Request For,1111 To: Iowa Dlvisiowol, Criminal lavosiigaitoh Support Qpera(tous Bureau, V Floor 215 I;. 7" Street Des Mollies, Iowa S03)9 (515) 725-6066 (515) 725-6080 Fay: oil: DCl Acc011n1 Number:'4(b�F (ifapplianblc} From: City of Iowa Cily City Clerh's Oftiee -- ---- 4I0 E. Washiniton Street Iowa C IA 52240 Phone; 319-356-5041 Vag: 319-356-549 9 �— (�l.Q QG� [-ILO r✓ �C', 70f Birth bnandaloq')Gender(mandaloryj Social Securi tale ❑Female --- _ /A Waiver rnforntaliofl: Without a signed waiver from the subject of the'reyuest, a complete criminal history record may uol be releasable, per Code of Iowa, Chapter 692,2, For complete criminal history record Information, as ullowed bylaw, always ohteht a waiver signs tore from the sib tet of the request. Waiver Release IherebpgivePe"lihsienfol theabonrgneslingOfficial 10canducta,jIMvaCriminal histulyrecordcheekwilblhcOivi5lonotcriminal tnv05680tion (DO). Any crimiuel hisloq' dale concealing uax Ilial is mainlaincd by the DCI may be released as allomcd by law, Waiver Si natflre: Towa Criminal T-TistolRecord Check Results As of a search of the Provided name and date of birth revealed No Iowa Criminal History Record fowld with DCI Iowa C1•iminal History Record attached, T)CIli Lf 03"c DLI DCI -77 (08/25/10) Received Time Jul, 20. 2016 1:53AN No, 9668 (UG I{se any } J u 1 25 2016 3'r,PIVI 0 1 v of I;rimina Investigation IOWA CRIMINAL HISTORY DCI 00403666 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00403666 2016/07/25 NAME: PIERCE,LEON RAY DOB SEK RAC HGT WGT EYE HAIR SKN POB 19960710 M W 501 170 HAZ BRO MED PA ADDITIONAL IDENTIFIERS CCH RECORD *** Nc. 8 64 6 01 ARRESTED 20021006 AGENCY: TA0520000 JOHNSON CO SO CHARGE NO- O1 IA STATUTE IA708-4 WILLFUL INJURY TRK#: 100602001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA708.2(3)-2 ASSAULT WITH A WEAPON - 1989 COURT CASE XO; 06521 FECRO63514 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100682003 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED JAIL 30D 20030313 JAIL 30D 20030313 PINE $500 20030313 PROBATION lY 20030313 PROBATION EXTENDED 1Y 20040313 COURT DISPOSITION AGENCY: IA05201SJ JOHNSON CO DIST COURT COUNT NO- 04 IA STATUTE: IA321.304(3) PASSING CONTRARY TO HIGHWAY SIGN/MARRING - .COURT CASE ID: 06521 FECROG3514 CHARGE CLASS: SCHEDULED TRAFFIC VIOLATION TRK#: 100682004 SENTENCE DISP EFF DAT FINE $50 20030313 c; cs• AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. 1141S RECORD'S Y.. '— 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 THXS RECORD IS: - BASED ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, r DIVISION OF CRIMINAL INVESTIGATION ARTS C410WADOT VVWW,t01/Ui3dOt.goV SMARTER I SIMPLER 1 CUSTOMER DRIVEN-- -- Inquiry 7/16/2016 Date: Customer #: 4603892 Name: Pierce, Leon Ray Address: 5032 3RD ST SW City/State: KALONA, IA 522479169 Mailing 5032 3RD ST SW Address: Mailing KALONA, IA 522479169 City/State: Date of 7/10/1976 Birth: Sex: age I of 1 office of Driver Services PC Box 9204 i Des Moines, IA 50306-9204 Phone: 515-244-9124 i BDO-532-1121 I Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: 349AE5700 (IA) CDL Permit Class: None Class: D Audit #: 1157946 Issue Date: 07/16/2016 Expiration 07/10/2018 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Pierce, Leon Ray DL/ID: 349AE5700 CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: 7/16/2016Office CDL Permit None Restrictions: ID Status: EXP DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None 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: Name: Pierce, Leon Ray DL/ID: 349AE5700 http://172.29.254.55/drivers/reportsleustomerhistoryleertifieddriviiigrecord.aspx 7/16/2016 ®�` - „Z0... i4 7/16/2016Office of Servicesiver oDepartment tof Tansportation Name: Pierce, Leon Ray DL/ID: 349AE5700 http://172.29.254.55/drivers/reportsleustomerhistoryleertifieddriviiigrecord.aspx 7/16/2016