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HomeMy WebLinkAbout16-236► r CITY OF IOWA CITY 410 Las[ Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. 1-0 ' 23( (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 3. Contact Information (REQUIRED) �-`fs M (All written communication sant via email) 4a. Driver's License expiration date (REQUIRED�)r o 3 / f 0 / �0 b. Taxicab Business Name (REQUIRED) y 2II Oy4 CAB B 5. Prior experience in transportation of passengers: et i EA ce 1✓I To � Gt C I'I'I 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When Pobl.,c Infos C,�y Iq8$ P 055e55ton nl�i R YO WfiAappened to the charge? (Circle one) 'T V WCi Ct ! I Q y AND 1719 Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? yes Type of offense Where When Fcti I +d ©5ey frcA;�, 5«, ncj —Tn,~,(I situ ao t 8L 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 Ive yeafs? o O Type of offense Where c1N en N " o i r^-,5 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide tt&ame(s) N 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 ertify that I have issued to me by the Iowa D part enI of Transportation a valid. river's license number 713/[ I issued on /g Ifl /{ I' expiring on I understand that if I falsely answer any in this application, that this app ical btl n may be denied. I agree th t 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, Ch9pter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant 14& 14471Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before CDC 5,6tt� zbl is 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 license D�v t% l Z,o I S _j 4 W� -4) X02( Signature 15f Polick Chief 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. SigSig atu�Clerk�g Irl -44/11, Date Office Use Only C Approved application DCI reportN State certified driving record - C) Website update C3erk.7A IDRNBADGEAPPL92016am do .DOC 0712016 0c t. II. 2016 9 : 5 1 A M D l v of Criminal Investigation TOrurr�u,o w :lureiiuw Cab or Iowa LILY No. 4976 P. 2 (FAx)3193382708 P. 002/003 STATE OF IOWA Criminal History Record Check 11111. xv'"4?01�111 Request Form Toi Iowa Division orCrindnal Investigation Support Operations Bureau,]" Floor 215 9.7" Street Des Moines, Iowa 50319 (515) 7256066 (515)'725-6080 Fax an Fu h(-rne i 5- r I )Act 17-777 M' DCI Account Number; _9967-F (Iroppitoable) From( Yellow Cab of Xowa Clry P.O. Box 428 Iowa City, IA, 52244 (319) 338-9777 Phone: Fano (319) 339-7302 Date of Birth (mmondilo R Gender (mandata 'Socinpl•Securl. Number (raeommcndsa ►V1aIe ©Female q 0 W41ver Information( Without a signed walvor tram the tub] eot cf the request, a complgte grlminol history r000rd spay not be releasable, per Code of Iowa, Chapter 692,2, For complete criminal hiatory-record Informntioa, as allowed by law, a).ways obtain u waiver slgnature (Tom the sublet( or the request, Walver Release; I hereby sly* pormbaloe for rho abave rcguaslins Onleial to conduct an Iowa aflmIntl hlnory r000rd check with the Division of Criminal ln.atlgstioa (OCE), Any 96mincl hhtory doll conceming ma Ih1111 melnlalned by thmay be r�esu4<s-0L�d�yJ Waiver Signature, (DCI use only) As of �� , a search of'the provided name and date of birth revealed; ❑ No Iowa Criminal History Record found with DCI �fjQ .� Iowa Criminal History kocord attached, DCT # �Sl 3 3CJ r., DCX initials DCI -77 (08/25/10) Received Time Ocl. 7. 7016 7:19AM No.ti69R Oct.11. 2016 9:52AM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00373688 NAME; FUHRMEISTER,TIM FUHRMBISTER:TIMOTHY WILLIAM FURHMBISTER,TIM FVRHMEISTER.TIMOTHY WILLIAM DOB SER RAC HGT WGT EYE 19680818 M W 600 200 BLU ADDITIONAL IDENTIFIERS TAT L ARM TAT L CALF TAT L LEG CCH RECORD *** 01 ARRESTED 19880403 DCI 00373688 PAGE 1 OF 2 DATE PRINTED - 2016/10/11 HAIR SKN POS BRO FAR IA AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#; L33958601 COURT DISPOSITION AGENQY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1975 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33958601 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 02 ARRESTED 19900401 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA204-401-3 POSSESSION.SCHEDULE I/MARIJUANA TRK#+ L32950701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA204-401-3 P09BESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33955701 SENTENCE JAIL 1D CREDIT W/TIME SERVED 8H 03 ARRESTED 19971005 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTR IA708-2A-2B ASSAULT/CAUSE INJURY/DOMESTIC TRK#: .037265101 DISP EFF DAT 19850415 19880415 19850415 DISP EFF OAT 19900703 19900703 No. 4976 " P. 3 Oct.11. 2016 9:52AM Div of Criminal Investigation No. 4978 P. 4 COURT DISPOSITION AGENCY: IAOS2015J COUNT NO- 01 JOHNSON CO DIST COURT IA STATUTE: IA236-2-2 DOMESTIC ASSAULT CAUSING INJURY COURT CASE ID: 06521 SRCR045754 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037285101 SENTENCE SUSPENDED JAIL 28D JAIL 30D FINE $250 PROBATION 1Y 04 ARRESTED 19981104 DCI 00373600 PAGE 2 OF 2 DISP EFF DAT 19900115 19900115 19980115 19980115 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA700-2A(2B)(3B) ASSAULT WITH INJURY/DOMESTIC/ENHANCSD TRK#: 044597001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA706-2 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 044597001 SENTENCE DISP EFF DAT JAIL 1D 19990223 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY 9E RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR PO$TTIVE 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 �`Y',yyrjI CJ10WA00T- wvvw i0wadot.gov SMARTER 151MPLER I CUSTOMER DRIVEN Office of Driver Services PO Boz 92041 Des Moines. V1 50306A204 Phone: 515-244-91241.800-532-1121 1 Fax: 515-239-1837 wwwJawadot.gov Certified Abstract of Driving Record Inquiry Date: 10/20/2016 DL/ID #: 713XX1449 (IA) CDL Permit Class: None Customer #: 1833101 Class: D CDL Permit Issue None Date: Name: Fuhrmeister, Timothy William Audit #: 7327449 CDL Permit None Expiration Date: Address: 2801 HIGHWAY 6 E LOT 245 Issue Date: 09/10/2013 CDL Permit None Endorsements: Expiration Date: 08/18/2018 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522402652 Endorsements: 3 ID Status: None Mailing 1401 MARCY ST Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522402117 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 8/18/1968 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions :itation Date Conviction Date ACD Explanation County JUR 38/03/2012 09/05/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 02/15/2013 1728650 IIA IA 02/18/2014 1787979 �.r Name: Fuhrmeister, Timothy William DL/ID: 713XX1449 Pursuant to Iowa Code 4321.10, 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: Fuhrmeister, Timothy William DL/ID: 713XX1449 10/20/2016 IOWA *4$ ). 0. T.::�y �j%iaa.rl t Jl `O8111%�-'- Office of Driver Services �.r Iowa Department of Transportation Name: Fuhrmeister, Timothy William DL/ID: 713XX1449