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Home My WebLink About16-217CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 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 2. Address (REQUIRED) �2 7 VQ 4120 St S W � 10,4ga fl�, �✓7� 3. Contact Information (REQUIRED) Email Cell Phone: /2 :Z!03 AL1 f(3 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) /,-7 -7 3 l�,/-r71 b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When %% 3-/ chaffge?VCecfe one) C —C 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 What happened to the charge? (Circle one) Where When (JI-17- What /-/7 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 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please When N Ga i fS� U7 Wide the4i 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 available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 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 issued on7 i / expiring on 9-a/- 2. I understand that if I y a falselnswer an questions in this application, that this application 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 /%,"z d Date 97-,Z9 /G STATE OF IOWA ) COUNTY OF JOHNSON ) to before me by 71 a t) r CQ h . 776m4t .% on this 7,!� day of WENDY S. MAYER Commission Number 729428 otaryPublic i and for the State 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 Coodd/�j _ e). / Expiration date of Driver's license "! 74 & cby ao Signature of Police Chief or designee IDate 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. )i(L44�c� -)� - `*F�y Signature of City Clerk or designee i Dab N O� tlNf IINNNNIHNIN!lNlNN1fN#ff#N#INNNNNf!!f lflf 1f!llfllflNflllfNlfiff#N#fiNNt}}#t}Yff}f}1N}M#!}11�e}fYfl11'ff;llfffNfNf J � a Office Use Only Approved application DCI report State certified driving record Website update aeNJrA%IDRN84DGEAPPL92014am ded.DOC 07/2016 y - c� aeNJrA%IDRN84DGEAPPL92014am ded.DOC 07/2016 09/,Sep. 26. 2016:73;02PM.ab Div of Criminal Investigation (FAx)31933827co.4786 P. 1/4002 �STATE OF IOWA Request Form To: lows Dlvlslon of Criminal lnvesllgation Support operations Bureau, 1" Floor 215 E. 7`^ Street Des Moines, Iowa 50319 (515) 725.6066 (513)'725.6080 Fax I am renuestino an Iowa Criminal H(stnry Renard Chenle en: DCl Account Number: 9967-I �_ (If applloable) Froml Yellow Cob of Iowa City P.O. Box 428 Iowa City, U. 62244 (319)338-9777 phohol Bam (319) 339-7302 Last Name (mandato First Name mandtlory) Middle Name (rocommcndod N Date of Birth mandatory) Golder (mandatory) 'Social,9ecurl Number (rawmmendod) / �/' / male ❑p'emale Q' � �g_ Waiver Information: Without a signed waiver from the subject of tho reg4est, a complt)to grlminal history record may not be releasable, per Code Df Iowa, Chapter 692.5, For comolete criminal history record Information, as allowed by law, always obtalll a walver signature from the subject or the request ' Waiver Re/ga$e: I homey etvo permission for the above retiuuans official to aendual an (ewa orhnlnel history record check with the Division of Criminal Invaliption (oCl). Any criminal history dun concern g me that Is molmained by the DCl may be Would as allowed by law. Waiver SignarurelIA-,e f;404 ►p Iowa Criminal History Record Chgch Regults (DCI use, only) p,l�J As of 7 , ti search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCT Iowa Criminal History Record attached, DCI 4O q f DO initials DCI -77 (08/25/10) Received Time Sep - 23. 2016 1:46PM Nlo.4619 Sep.26. 2016 3:03PM Div of Criminal Investigation No.4186 P. 2/4 IOWA CRIMINAL HISTORY DCI 00209152 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - 2016/09/26 DCI:00209152 NAME: TOOMER.DAVID ALAN DOB SEX RAC HGT WGT EYE HAIR SKN POB 19560921 M W 511 200 BRO HRO MED IA ADDITIONAL IDENTIFIERS SC CHIN SC R KNEE CCH RECORD *x• 01 ARRESTED 19780203 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 DRIVE UNDER INFLUHNCS/LIQUOR TRK#: L10173201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE - OPERATE MOTOR VEHICLE UNDER INFLUENCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10173201 SENTENCE DISP EFF DAT JAIL 10D 19791120 02 ARRESTED 19860716 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L10173401 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10173401 SENTENCE DISP EFF DAT JAIL 2D 19860717 N P_ 03 ARRESTED 19901103 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 N OWI TRK#: L10173501 COURT DISPOSITION _- AGENCY: IA0520ISJ JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10173501 SENTENCE DISP EFF DAT Sep.26. 2016 3:03PM Div of Criminal Investigation DCI 00209152 PAGE 2 OF 3 JAIL 2D 19910214 FINE $500 19910214 CREDIT W/TIME SERVED 14H 19910214 04 ARRESTED 19901103 A AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321-263 LEAVE SCENE OF ACCIDENT TRK#: L10173601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321-261 LEAVE THE SCENE OF PERSONAL INJURY ACCIDENT CHARGE CLASS: M1513EMBANOR CONVICTION TRK#: L10173601 SENTENCE DISP EFF DAT JAIL 10D 19920214 CREDIT W/TIME SERVED 14R 19920214 05 ARRESTED 19921001 AGENCY• IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFFENSE TRK#: L10173701 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: OWI/2ND OFFENSE - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10173701. SENTENCE DISP EFF DAT JAIL 30D 19930129 FINE $750 19930129 06 ARRESTED 19931126 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA221J-21 DRIVING WHILE REVOKED TRK#: 006568001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: 1A321J-21 DRIVING WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 006588001 SENTENCE DISP EFF DAT JAIL 2D 19940304 No. 4186 P. 3/4 Sep. 26. 2016 3:03PM Div of Criminal Investigation IN 0. 4100 FINE DCI 00209152 PAGE 3 OF 3 $250 19940304 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 DCI. 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 1i /CA0r0nJ10WA00T vvww,iovvadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry 9/27/2016 Date: Customer 1934738 Name: Toomer, David Alan Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 wwwrowadol.gov Certified Abstract of Driving Record DL/ID #: 127AC6033 (IA) CDL Permit Class: None Class: D Audit #: 9285470 Address: 2742 500TH ST SW Issue Date: 07/28/2015 None Endorsements: 863060 Expiration 09/21/2023 Restrictions: IIA ID Status: Date: DL Status: City/State: KALONA, IA 522479214 Endorsements: 3 Mailing 2742 500TH ST SW Restrictions: Corrective Lenses Address: Restriction None Mailing KALONA, IA 522479214 Supplement: City/State: Date of 9/21/1956 Birth: Sex: M History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration Date: L1/17/2013 CDL Permit None Endorsements: 863060 CDL Permit None Restrictions: IIA ID Status: EXP DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Ntation Date Conviction Date ACD Explanation County JUR L1/17/2013 112/09/2013 N82 Improper Backing Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Occident Date Case Number JUR L1/17/2013 -767955 IA ry )6/10/2015_ 863060 IA o )1/29/2016 1904490 IIA Name: Toomer, David Alan DL/ID: 127AC6033 ^,a _.a 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: Toomer, David Alan DL/ID: 127AC6033 9/27/2016 Office of Driver Services Iowa Department of Transportation tV l'J C0