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HomeMy WebLinkAbout16-254IDENTIFICATION NO. IL,, 1 l 1 (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (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 First Middle Last 1. Name (REQUIRED) k) 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: �enr /y�%. ®tyrn,,; I Cell Phone: '� DIY (AII written corrifnunication sent via email) 4a. Driver's License expiration date (REQUIRED) CkS i b. Taxicab Business Name (REQUIRED) i/rJ,ixo 0., , 5. Prior experience in transportation of passengers: VJAI� CAh- wrc 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? rths Type of offense Where When What happened to the charge? (Circle one) 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 Where When �IDl"1'mss 8.0 n U' )) C1' , r �' / `. zm What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended 6iGuil Other cn 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _jVn Type of offense Where Wtien E7 —T] - r• 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide th@,nam(,gy 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 certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number La "7 YYAnIq issued on TLS expiring on I understand that if I falsely answer any questions in this application, that this application may be denied. I agl ewe the hat 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 ApplicanL.404„ A,, Date //// STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed ano sworn to before me by t'� �l�Ozs2- A . 7�L-(,5 on this / Y day of 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 L //k/2_ZY2_� 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. ,!Sigi3bture of Ciq Clerk or designee i I�/4-llCo Date v--------------- Office Use Only o Approved application DCI report (-3-C�-- State certified driving record - { M Website update r-1 ,a ED 0 aWxi MDRNanocEAPPLe2014 � ded.Doc 07/2016 ! Iowa Department of Transportation d offim nmt:r sL�ces (rdl Heel M 53 11121 0 PO Boot 93114, Keel Milnes, U 5C13OG92114 515-244-3124 0 FAX:515-239-1937 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 11/8/2016 DL/ID #: 627XX6064(IA) Customer #: 2375713 Name: Phelps, Gilbert Allan Class: A ID Status: None Address: 1206 E COURT ST Audit #: 9079785 DL Status: VAL zone Issue Date: US/13/2015 CDL Status: VAL City/State: IOWA CIN, IA Expiration Date: 05/14/2020 CDL Cert Status: Non-ExIntrastate ted 522403234 Endorsements: L CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: CDL Intrastate Lenses, Restrict Suppltii ent: None Date of Birth: 5/14/1958 Mailing IOWA CIN, IA Sex: M City/State: 522403234 History Information Convictions Citation Date Conviction Date ACD Explanation Countv 3UR 02/05/2013 02/25/2013 S92 Speed (10 mph & Buena Vista IA under in 35-55 mph zone Name: Phelps, Gilbert Allan DLAD: 627XX6064 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: 11/8/2016 •�� IfJWl4 4 D. Q. T.;•% WIN Office of Driver Services Iowa Department of Transporation 10,0ct.14. 20164 1:49PMoebDiv of Criminal Investigation (Fax)3I93382:No.5422 ' STATE OF IOWA Record tCheck . Request Form To: lewd ]Division orCrlmlnal Investigation Support Operations Bureau, 1" Floor 215 L. 7" Street Dos Moine,, lova $0319 (615) 72S•6D66 (515)'725.6080 Fax P. 1/1/002 DCI Account Number: _9967-F ltlappllaable) From: Yellow Cab of Iowa CI RD. 9ox 428 Iowa City, IA. $2244 Phone: (319) 339-9777 FAx: (319) 339-7302 ENale ©Fernale waiver 111VOrmaffon: Wlthout n nlgned wAlver from the subject of the request, A eomplgta grlminal history record may not be releasable, per Coda of Iowa, Chapter 692.2, For gom^g,�leta criminal history -record Information, at allowed by law, always obtain a wA Iver steno turn Mnm thn cnhrww..r.,.......... WWVer RC%ase: I hereby Siva perml,alon rot the 4bovo requesting *metal to aonduol en Iowa criminal htrtoy record ahoag With IN Division of Criminal Invasltt:atian (DCI), My csiminol hl,lory dote conceml��n••,S7�mo thea Is tnalAratned by Iha DCI May be released as allowed by law, Waiver Sienafur&t rt05(�J: 0�. As of _ AD -I (.W �, , a search of the provided name and date of bitch revealed.- No evealed: No Iowa Criminal Hlstory Record .found with DCI ❑ Iowa Criminal Ristory Record attached, DCI bCI initialg�_ DCI -77 (09/25/10) Received Time Oct. 12. 2016 12:56PM No.5919 (Oct use only)