The URL can be used to link to this page

Home My WebLink About16-168CITY OF IOWA CITY 4 10 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 3S6-5497 FAX IDENTIFICATION NO. (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 1. Name (REQUIRED) .J.a 2. Address (REQUIRED) Z 7� r})/ /� �� f i C a 4-4Ci �` -zR 3. Contact Information (REQUIRED) Email:�n �r )-t > Z3 32�g0)1 Cell Phone: All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) -/ZZ. b. Taxicab Business Name (REQUIRED) /Y f/ cmAV 5. Prior experience in transportation of passengers: n n >1 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? c i Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other:: �t?I Have you been arrested / charged with any traffic offenses in the last five years? /1 L> v i Tvce of offense Where When-, � What happened to the charge? (Circle one) 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 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certi tat I have issued to me by the Iowa Department of Transports .on a valid Driver's license number nR issued on 6 expiring on 9t IL5 1 understand that if I falsely answer any questions in this application, that this aplicAtion may be denied. I a ree 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 provision"Title hapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican Date ,1HH,ltit*1fYfH1HYHffH,f fIfTHH,i'IM+fYff fHHTHHHff f f 1ff111H1Hf1.lTiffflfffYH,1fHH.HHfffllYfTTiH#f f f1fHH,H1HffY'f1f1H111H STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed ind sworn tow before me by �O kuu jfkl,05 on this ��L 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). 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. Signaltwe of City Clerk or designee ?/(:).5 /i2 Datef 11HTHTTTTT11ffYflflllfMffYf IfIHHTTTf YITllff YflffflTfff111111fTHTHIHTHHTT1H441f11ff11f111ff11T1H1fNTT111k111W flffff1f11fflffflfflf C� Q� Office Use Only c i� Approved application P DCI report State certified driving record Website update Gen✓rnxIo BADGEAP ls201�ooc 0712016 w Gen✓rnxIo BADGEAP ls201�ooc 0712016 Oug.24, 2016 12:18PM Div of Criminal Investigation No, 1435 P. 2/3 •� Fro n4:Cliy o1 1 -we City Clerk Of/lac 319 3666497 06/18/2018 10:24 4SO34 p.002/002 oN<..ersuy <STATE OF 10TIVA Crdmfimal History Iosnh qCheck RequestForm' *�� Yo: Iowa ]Division of Crim(nal Investigation Support mperztlons Bureau, 11r Floor 215 E. 7lh Street Iles Molues,loyla 50319 (SIS) 725-6066 (515) 725-6080 leax au Tows DCJ Account Nmnber:ao — I' (ifayplicable) From- cit of lawn City City Clerk's office 410 E. Washin ton Sttat Iowa Clay, IA 52200 Phoue: 310-356-5041 Fara: 319-356.5497 Date of Birth I t~e-A--. L ®Male ❑Female -/c� y' -7i` —611) Wdiverhi1b;, vrafion., without a signed waiver A,= (hesubjact af the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For completC criminal history reeol'd informaiion, as allowed by law, always obtain a waiver signature from the sttblect oftha request Waiper Release; I hereby give rcnnission fertile above, raguea(ing official to-tandua an lonm criminal hinory rccofd check will, the Division of Criminal Investigation MCI). Ahy criminal hiSlory dela ennccrn) ath9 s maintolned by dro DCJ may be rehased as alloned by IS% Waiver ioizatdfre: - ---___-_- (Muse only) �s of i so e search of the provided namg and date of birth revealed: I: ® NO Iowa Criminal HistolY Record found with DCI IOWA, ClitninalHisloryRecord attached, DCI # ci� ,�'js r• o - DCT initials_ DCI -77 (08/25/10) - Received Time Aug. 19. 2016 10:09AM No.2.192 Au g.24. 2016 12:19PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00389325 PAGE 1 OF 1 DATE PRINTED- DCI:00389335 2016/08/24 NAME: ANDREW9,JOHN FREDRIC DOE SEX RAC HGT WGT EYE HAIR Sm POB 19630102 M W 509 260 RAZ BRO MED IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19890510 AGENCY: IA0820200 DAVENPORT PD CHARGE NO- 01 IA STATUTE IA708-7 HARASSMENT TRK#: L36031301 CHARGE NO- 02 POSS DRUG PARAPH TRK#: L36031302 COURT DISPOSITION AGENCY: IA082015J SCOTT CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-7 MARA99MENT TRK#: L36031301 SENTENCE DISP EFF DAT PLEAD GUILTY 19890607 FINE $25 19590607 COURT COSTS 19890607 COURT DISPOSITION AGENCY: IA082015J SCOTT CO DIST COURT COUNT NO- 02 IA STATUTE: PUSS DRUG PARAPH TRK#: L36021302 SENTENCE DISP EFF DAT FINE $50 19900510 COURT COSTS 19900510 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 RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCT, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 1435 P. 3/3 C4610WADOT EN VUWW.IOWadot.goV SMARTER 1 SIMPLER I CUSTOMER DRIV Office of Driver services PO Box 9204 I Des Moines, IA 50306-9204 Phone: 515-244-9124 1 80D-532-1121 i Fax: 515-239-1837 www.iowadat.gov Inquiry Date: 8/25/2016 Customer #: 1621134 Name: Address: City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: Andrews, John Fredric 832 RUNDELL ST Certified Abstract of Driving Record DL/ID #: 152BB9099 (IA) Class: C Audit #: 8774112 Issue Date: 01/18/2015 Expiration Date: 01/02/2020 IOWA CITY, IA 522406254 Endorsements: NONE 832 RUNDELL ST Restrictions: NONE Restriction None IOWA CITY. IA 522406254 Supplement: 1/2/1963 M History Information CLEAR DRIVING RECORD Name: Andrews, John Fredric DL/ID: 152BB9099 CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: Office of Driver Services CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG 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: •- -•: ;�4� 8/25/2016 IOWA 4°y DAIVE9 �0 Office of Driver Services `f �..� Iowa Department of Transportation Name: Andrews, John Fredric DL/ID: 152BB9099