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HomeMy WebLinkAbout16-245IDENTIFICATION NO. (Office Use Only) ,�t �r"IIIIrJEE���� APPLICATION FOR TAXICAB / MOTORIZED PEDICAS VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday —Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required" Information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX rst Middle st 1. Name (REQUIRED) //�� 2. Address (REQUIRED) 100 Ld/a tit/ _ S22'f f 3. Contact Information (REQUIRED) Email: Gt! p4a^I�CeIIPhone.31q'y©D-,2_ (AUWritten communication sent to ee at 4a. Chauffeur's License expiration date (REQUIRED) / - %q Izo /O b. Taxicab Business Name (REQUIRED) /7 I 5. eXperi n e in transportation of passenger' s: tj a )- r/ ( of * r Z{ 6. Have you ever been arrested //charged with any isdemeanors and/or felonies in thls tate r elsewhere? Tv o eT��G76�C/ e►CC ^ �GS Where~n[S Co, /When o 7� 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 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 prcvi5le the'-namta(s) ; 14 1) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE i;El2TIFIED Ffli 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) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have Is ued to me by the Iowa De rim nt of Transportation a slid hauffeues license number !D - . ' . issued on expiring on 4 I understand that if I falsely answer any questions in this application, that this a lic tion may be denied. I ree t at in making this application, 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 provision7"" 5, Chap r 2, of hPCode. (Needs to be signed in front of a Notary Public) Signature of Applicantc Date % !? M**M*##*kM#t*M##k#M#MiYr*Y##1k#t%1fk1-Ft#k!t#flk4!!*IkMMM##**####k#*#d*##***k#M**k**vFkfl.!kRk1k#F#Rtt*kttlilM*41F!!! k#;1r1tf*:H:4**!M STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by &!=L 1 _ . Ca t. {�.�, on this —7 day of A.Ar: 1 —L61 1 n . 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 Chauffeur's licensee! �C0hd16 Signatur olice 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. Signature of City Clerk or designee A<'/6 Date M#!!YY#YMM###M#e#1tfli!#llx1LY#####fX!#ihY##M##M*#L#-A#)##ft###M#MY#.YUY.I *........ Ml1lfM#####YRYf#F C� Q, Office Use Only Approved application DCI report _R S + i State certified driving record j v j Website update OvW MDRNBADGEP FMG14a'n Od.DOC 03/2015 ,O3/;Mar,29. 2016,610:02AN6bDiv of Criminal Investigation (FA%)31933827LNo,0890 P. 4/6002 OF IOWA �'I.1Jv 1 �t�21Crimiiial STATEHistoryRecord Request Form �S;,l1n11111� �' ?al town Dlvlston or criminal Investronan Support Operations Bureau, V Floor 2151t. T" street Dos Molnar, lows 50319 (Sig) Z25-6066 (615)'924.6060 Fax Iam rwuedlne an Iowa Criminal Hfatnm Reenrd Ghnale nm DCI Account Number: 9967-F (ifgppIkable) Frame Yellow Cab orlaws Citi P.O. Dok 428 Iowa City, IA, 52744 (319) 3369777 , 1'honol Fox, (319) 339-7302 Loot Name nUadgto First Name mandglo Middle Na a remmmended Date of Hirth mangsiM2 Gendde (mangers Social -Security Number neommenfi Walyer Inf malrlonr Without a siprted lvnlver from the subject of the regpest, a eomplote grlminal history record )pay not be roleasoblo, per Coda of Iowa, Choptor 692,2, For complete erinrleal hlstory•rdeor4 Information, at allowed by jaw, always obtain a Waivers) nature from the subject of the ro pest, WalydrRdleasmIhoneyglrapemilulanFor Olt above a all to elaolowsedminslhlnaryuoordcheckwithsnplvislanateraMml lavarlltgeon (OCib My crWml hlimy dnn conecming i Is Il!1U:06rr;nffQlA1 be rlloged µ etlow/e by IIw. Walver Sfgira r As of . _A(a it search of the provided name and data of birth revealed: i!, Q No Iowa Criminal History Record found with ACI r Iowa Criminal History 12ecord attached, DCI 0 55b 1 Z.3 DCI initials DC1,77 (08/25/10) Received Time Mar, 21, 2016 2:34PM No. 0742 Mar.29. 2016 10:03AM Div of Criminal Investigation No -0890 P. 5/6 IOWA CRIMINAL HISTORY DCI 00558123 MISU MEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRUTED- 2016/03/29 ncI:00558123 NAME! SMITH, GARY LBE DOB SEX RAC NGT WGT EYE HAIR SKIN POB 19581019 M W $00 230 BLU SDY FAR IL ADDITIONAL IDENTIFIERS PHOTO AVAXLABLE: Y CCH RECORD +++ 01 ARRESTED 19980815 AGENCY; XA0560000 LOUISA CO SO CHARGE NO- 02 XA STATUTE IA123-46 PUBLIC INTOX TRK(#L 038959602 COURT DISPOSITION AGENCY: ZA050015J LOUISA CO DIST COURT COUNT NO- 02 IA STATUTE: IA123-46 CONSUMPTION -PUBLIC INTOX CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 038959802 SENTENCE DISP EFF DAT FINE -AgbD COSTS PAY SURCHO 19980930 03 ARRESTZO 20100517 AGENCY: TA0290000 DES MOINES CO SO CHARGE NO- 02 IA STATUTE IA123.46(2)-A CONSUMPTION OF ALCOHOL IN A PUBLIC PLACR 2 COUNTS TRK#: DA002VW02 CHARGE NO- 03 IA STATUTE IA719.1(A)-1 CONSPIRACY - 0001 TRK#: DA002VWD3 COURT DISPOSITION AGENCY; IA029025J DES MOINES CO DIST COURT COUNT NO- 01 XA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 COURT CASE ID: 08291 SMSM031717 CHARGE CLASSe MISDEMEANOR CONVICTION TRK#: DA002VW02 SRNTENCR DISP EFF OAT o FINE $65 20110316 COURT DISPOSITION AGENCY: IA0290ISJ DES MOINES CO DIST COURT COUNT NO— 02 IA STATUTEi IA719.1(1)A a� INTERFERENCE W/OFFICIAL ACTS "? COURT CASE ID: 08291 SMSM031717 "`- CHARGE CLASS: MISDEMEANOR CONVICTION.` TRK#: DA002VW03 SENTENCE DISP EFF DAT FINE $250 20110316 Mar.29, 2016 10:03AM Div of Criminal Investigation DCI 00558123 PAGE 2 OF 2 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 NOW -LAW ENFORCEMENT AGENCIES BY THE DCI, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 0890 P. 6/6 $:•,�raRTF& [ SiNiPlIt+ 1 £UaT4'JR fah`ItiFtd w wviowadot.gov Office of Driver Services PO Box 2294 t Des Moines. IA 59306-9204 Phone: S15-244-91241800-532-1121 1 Fax:515-235-1e37 www-lowadot.gov Certified Abstract of Driving Record Inquiry Date: 4/7/2016 DL/ID #-. 707AI8376 (IA) CDL Permit Class: None Customer #: 747183 Class: D COL Permit Issue None Date: Name: Smith, Gary Lee Audit 0: 7984891 CDL Permit None Expiration Date: Address: 956 BOSTON WAY APT 2 Issue Date: 04/16/2014 CDL Permit None Endorsements: Expiration Date: 10/19/2018 CDL Permit None Restrictions: City/State: CORALVILLE, LA 522413170 Endorsements: 3 ID Status: None Mailing 956 BOSTON WAY APT 2 Restrietions: NONE OL Status: VAL Address: Restriction None CDL Status: None Mailing CORALVILLE, IA 522413170 Supplement: CDL PQrmlt Status: EL.G City/State: Date of Birth: 10/19/1958 CDL Cert Status: None Sex: M CDL Med Status: None History Information Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD explanation IUR 05/16/2010 .Al2 OWI Test Refusal IA Accidents - Accident Involvement Indicated does NOT mean the individual was at fault or given a citation. Accident pate Case Number 31JP 03/31/2015- 852459 -»IA Sanctions I ype F.f7ective End kCD Explanation Occurrence JUit .IUR Revoked 05/27/2010 '05/26/2011 :Al2 :OWI Test Refusal JA IA Name: Smith, Gary Lee OL/ID: 707AJ6376 m 'J Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportatlon, 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. ° �7 In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Aflkeffh-Iowa tMs.,date: - � N r 0 a6y 4/7/2016 �° iowA •:�4 � c�J �f•Qaia£` Office of Driver Services