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Home My WebLink About16-248� A � r 1 CITY OF IOWA CITY 410 East Washington Streel Iowa City. Iowa 52240-1826 (3 19) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (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 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQUIRED) - b. Taxicab Business Name (REQUIRED) y>,i 5. Prior experience in transportation of passengers: ?.ke- jid-Yfoln54„co, communication sent via email) Phone: -51l-5z7-/-9(A6 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Convi ` Dismissed Deferred Suspended lead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years.�� , Tvpe of offense Where _ W han 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 9. Have you ever Where When to be an Iowa City taxi driver using a different name? If yes, please KQitide t}�F I DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE6ER1*1ED.-- 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 t I �1ave sed to me by the Iowa D pa ent of Transportatio a alidg Driver's license number f Ufr2 issued c 6 expiring on I understand that if I P 9 falsely answer any questions in 1his application, that this a Ii ion may be denied. I agr a 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 applic o , and I further a re h , if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions Ti 5, hap it e. (Needs to be signed/"f'opt of a Notary Public) Signature of Applican Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed ano sworn to before me by C IA d �1 P L Kclo on this —% day of V*WVg;;:,,.I Notary Public in a for the 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). q Expiration date of Driver's license Signature of Police 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. C &A4.4 J _e. V-7/ Signat f City Clerk or designee I Date --1 E Office Use Only T„ ;w Approved application y DCI report State certified driving record Website update Clerk/TAXIDRIVMDGE PL92014amended.DOC 07/2016 Nov. 2. 2016 3:04PM Div of Criminal lnvestlgatlon No.6661 P. 2/4 VI l - w- u„y clorn Vlllvv JIM J000•.tlI 10/27/2016 16:I.0 *72w r..sv2/002 �, STATE OF IOWA Ciriminal History Record (Check e7-: " Request Form To: (owa Division of Criminal Arvestigation Support Operations ]]ureas, I" Floor 215 L, 7" Street Des Mollie$. Iowa 50319 (515) 72S-6066 (515) 725-6090 Fax 7 alit reQUestirla all 3/ �, / 51 DO Account Number: L4C--)OZ L_. (i f applicohle) From: Citof Iowagy City C1erIPs Office _ —"' 410 E. Washington Street tow" City, IA 52240 Phone: 319-3S6-5041 Fax: 319-356-5497 EJMilk ❑Female / 33 Waiver infOrnln/ion: Without a signed waiver from the subject of the request, It complete criminal history record may not be releasable, per Code oflowaI Chapter 6912. For complete criminal history record information, as allowed by law, ahvays Obtain a waiver signature from the subject of the reauect_ Waiver Release: l hereby girt permission for the Investigation (DCI). Any aiminal historydata emRtrnir n1ftiver ssignatfire: history record cheek with she Division of Criminal i allowed by lam. Iowra Criminal Hi itory Record Check Results 7 (DCfi Comh) Asof— C— )C? a search of the provided name and date of birth revealed: ® No Iowa Clfininal History Record found with DCl t Ioyva Criminal History Record attached, DCI #_��L� DCI initialslw_ w DC7 -77 (08/25/10) Received Time OcL21. 9016 3:00PM No.6320 Nov, -2, 2016 3:04PM Div of Criminal Investigation ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD **+ Ol ARRESTED 19760111 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 DRIVING UNDER INFLUENCE LIQUOR - TRK#: L10992802 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: DRIVING VNDER INFLUENCE LIQUOR - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10992801 DRUNK DRIVING SCHOOL SENTENCE PINE $300 DL REVKD INDEF 02 ARRESTED 19030715 AGENCY: IA0520200 IOWA CRIMINAL HISTORY DCI 00215009 MISDEMEANOR CONVICTIONS ONLY PAGE I OF 2 AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- OS IA STATUTE: IA123-46 DATE PRINTED - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10992901 Jrr SENTENCE 2016/11/02 DCI:00215089 6 DOLLS COSTS FINE $27 03 ARRESTED 20111005 NAME: KAPP,CHARLES LEO JR CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF DOB SEX RAC HGT WGT EYE HAIR SKN POB 19510309 M W 600 255 HA2 GRY COURT CASE ID: 06521 IA 19510409 ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD **+ Ol ARRESTED 19760111 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 DRIVING UNDER INFLUENCE LIQUOR - TRK#: L10992802 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: DRIVING VNDER INFLUENCE LIQUOR - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10992801 DRUNK DRIVING SCHOOL SENTENCE PINE $300 DL REVKD INDEF 02 ARRESTED 19030715 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L10992901 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- OS IA STATUTE: IA123-46 PUBLIC INTOX CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L10992901 Jrr SENTENCE PLEAD GUILTY 6 DOLLS COSTS FINE $27 03 ARRESTED 20111005 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF TRK#: 1AOOCWU01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCRO95839 DISP EFF DAT 19760315 No.6661 P. 3/4 o_ Jrr rQ E� Nov. 2. 2016 3:04PM Div of Criminal Investigation No.6661 P. 4/4 DCI 00215009 PAGE 2 OF 2 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A00CWU01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFP DAT JAIL 5D 20120406 COURT REVIEW 11-01-12 FINE $1250 20120406 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 ci G^ mn '� n t �'.'(" { C410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN VVWW"IDWsCIOt 9DV Inquiry Date: 10/11/2016 Customer is 923965 Name: Kapp, Charles Lea Jr Address: 823 BOWERY ST City/State: IOWA CITY, IA 522405602 Mailing 823 BOWERY ST Address: Mailing IOWA Crit', IA 522405602 City/State: Date of Birth: 3/9/1951 Sex: M Convictions Office of Driver Services PO Box 9204 1 Des Moines, IA 50396-92D4 Phone: 515-244-9124 1 8DD-532-1121 1 Fax: 515-239-1837 wiNw_owadot.gov Certified Abstract of Driving Record DL/ID a: 059BB9284 (IA) CDL Permit Class: None Class: D CDL Permit Issue None Uohnson IA Date: 04/06/2012 Audit Si 1186626 CDL Permit Expiration None Date: Issue Date: 07/29/2016 CDL Permit None Endorsements: Expiration Date: 03/09/2019 CDL Permit None Restrictions: Endorsements: 3 ID Status: VAL Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit Status: ELG CDL Cert Status: None CDL. Med Status: None History Information atstlon Date Conviction Date ACD Explanation County JUR t0/05/2011 04/06/2012 I_ 0010__ A20___ _ �ODemtlng While Intoxicated Uohnson IA L0105/2011 04/06/2012 N01 Ifall to yield Right of Way Johnson ]A Operating While Intoxicated Test Refusal/Test Failure Violations 3ccurrence ACO Explanation JUR _ 0101.. 1011 0010.. ..0000_ _ _ _. 01000000 LO/05/2011 lA98 OWI Tett Failure )U Sanctions Effective End ACD Failure _ tent of Iowa Nne CJS Name: Kapp, Charles Leo Jr DL/ID: 059BB9284 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hfr'e?ftne ertlry-t I em 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:0ilody of 61.g office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. .1- ,s 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: -4tEHICIf t y IOWA'�t '4:D. 0. T. 10/11/2016 �qw�op Office of Driver Services Iowa Department of Transportation Name: Kapp, Charles Leo 7r DL/ID: 059BB9284 y1 C] v