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Home My WebLink About16-260CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 82 6 Q 19) 356-5040 Q 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 h/ Middle nTT i -t Z,C,. LA S,,i- y Last 3. Contact Information (REQUIRED) Email: AI0Ur2CwP64,2LL l N /it 7m 4 ZL Cell Phone: 30- ✓-?e-5ff y / (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) I 1 - I G - ?0 a (, b. Taxicab Business Name (REQUIRED) C Al 5. Prior experience in transportation of passengers: YE L L6 c� C A 13 6- Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When (6VC1Z 1115) ALSG S&4 AVrAC14CO 067' fVL-RY%x irr (� e.,r 9 _ e z S Ont REVb2i(i SzIJC 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 I�1-E4S6 SEE" A71`40460 OIZTyIr1h 12E60:21-) A4k 0,4 IZEV61250 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? ^f C2 co5 Type of offense Where Wharf;-, 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pfavide the narrFV) 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 � _ a � -�3 1?EGKLGS$ 1/Sr GY L XPLGSf✓LS l YZIZEwG/2KS� d �i lS AiDMESZC�ZC A gVSE7 vZC TY Z";r,,/ INUZt7Y — 1 4 P1I6r .4,tj tq � I�LHo J 1, vzG Tc% IL Cl LI OF Com>RoLtt;l) Svd. UZS x,15 S �l� q- l k •- /6 1-3w3. Z,,i%Ox / e tzt %Y 'q -11, 'lS 'Dv13 Z";r,,/ INUZt7Y '►2A FrZ C a - 13 - Roo S awr l ofec- zizlaO — L4 — I Ll F-4 'r L TO 013 c"Y ?i2aF1=ZG SZ� �a L 8 - 31 — 1 4 f hL L 'Cr C/13ay �,ZArFLC SZl„/9 L IL Cl Fl rt 70Ga�Y=/�z� SzC,.14 � .a 1� J cn IL Cl 0 N 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 �y 3 Y Y , 6195 issued on 0-0 -15 expiring on 1 I -10 �70 . I understand that if I falsely answer any 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 _ _�Y" ` Date /1 -30 - / 6 STATE OF IOWA ) COUNTY OF JOHNSON Subscribed and sworn to before me by on this 3o day of au1� t a�tary Publ in and for the State of Iowa 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 h6 l to 1201/0 0� �--► I r33� l?)1-b Signature of Police Chief or designee ate 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. Sign—e of City Clerk or designee Office Use Only �Dafe N Approved application DCI report > Q.3 --c tS State certified driving record Website update .=q(.I CZ) _<r— rT7 c.,tac 4�_ DeiklrAXIDRNBADGFAPPL92014amended.DOC 07/2016 C1410'WADOT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry 11/30/2016 Date: None Customer 4989471 CDL Permit Issue None Name: Pearl, Andrew Astro Address: 1909 1/2 MUSCATINE Audit #: AVE City/State: IOWA CITY, IA 522406409 Mailing 1909 1/2 MUSCATINE Address: AVE Mailing IOWA CITY, IA City/State: 522406409 Date of 11/10/1961 Birth: Sex: M Convictions Page 1 of 2 Office of Driver Services PO Box 9204 1 Des Moines, W 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 www.iowadol.gov Certified Abstract of Driving Record DL/ID #: 683YY0685 (IA) CDL Permit Class: None Class: D CDL Permit Issue None 07/13/2005 A20 Date: OWI Audit #: 9638163 CDL Permit None M14 Fail to Obey Traffic Expiration Date: ;Johnson Issue Date: 12/12/2015 CDL Permit None Fail to Obey Traffic Sign/Signal Endorsements: IA Expiration 11/10/2020 CDL Permit None Date: Johnson Restrictions: Endorsements: 3 ID Status: EXP Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation County JUR 02/13/2005 07/13/2005 A20 Deferred Judgment OWI Johnson IA 08/04/2014 09/02/2014 M14 Fail to Obey Traffic Sign/Signal ;Johnson IA 08/31/2014 10/02/2014 M14 Fail to Obey Traffic Sign/Signal Johnson IA 01/14/2015 04/08/2015 ;M34 Fail to Obey Traffic Sign/Signal Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations )ccurrence ACD Explanation JUR 12/13/2005 Al2 IOWI Test Refusal IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Lccident Date Case Number JUR X8/04/2014 811462 IA Sanctions 'ype Effective End ACD Explanation Occurrence JUR JUR .evoked 02/24/2005 02/24/2006 IA12 IOWI Test Refusal ,IA IA 11/30/2016 Page 2 of 2 Name: Pearl, Andrew Astro DL/ID: 683YY0685 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: '•:�`pi 11/30/2016 IOWA D. 0. T. ��L U �f D91VEA$i/ Office of Driver Services Iowa Department of Transportation Name: Pearl, Andrew Astro DL/ID: 683YY0685 11/30/2016 N1 v. 21. 2016 9:29AM Div of Criminal Investigation No. 8520 P. 1/3 Rrom:crly mf Ie Wa 011Y CIcrk Office a19 3666697 11/15/2016 16:11 *739 P.002/002 STATE •L{ -1F ROW'A criminal History Record Check 9`1 Request Form, f o: Iowa Division of Criminal Investigation Support operatious Bureau, 1's Floor 215 L. 7", Street Dog Moilles,Iowa 50319 (511)'125-6066 (S S) 725.6090 Farc �� - I am reauestine an Iowa Criminal I3istoro Record Check on: 17C1AceountNuntber.__ (1.Qo•Z.—r (iCappliteble) " From; City of IOWA City City Clork's office 410 L. Waehinp-lon Street Iowa City, IA 52240 Phone: 319-356.5041 Fax: 319-356-5491 Last Nanle (mndatory) First Noma (Inandatmy) Middle Name (recommended) hli/+(ZL /I i -t9 12 GW 4 5 7'12 0 Date of Birth (mandatory) Gender (mandatory) Social Seciavi( Number (recommended) 1(-/0 —6/ Mmale ❑Female '19 L/- 9) - q3G 9 Waivev Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter692.2, For complete criminal history record information, as allowed bylaw, always obtain a welver signature from the sub ect of the request. WaiVer IieleoS& l hereby give permission for the abovercghertingoffreial so conduct an Iowa criminal hisloly retard eheck,vlth rhe Division oCCrinlinal Invesligalion(DCI). Any criminal hisloq, data cone6u'n^^ingmmfCha_s ismeimained by the DCl may ire released as allowed by larv, Waiver Signature: `�"qy��\ lgwa Criminal Histol Record Check Results (bcr use Only) As of '� 1 �e1 a search of the provided name and dale of birds revealed; No Iowa Criuljnal History Record fowld with DCI "• ; ®' Iowa Criminal History Record attached, DCI t/ 6� J� DClitulials 00,77 (08/25/10) o...;,,.,1 T:.� MA%, 19 1016 1.67PM Nn Aldo Nov, 21, 2016 9:29AM Div of Criminal Investigation No. 8520 P. 3/3 DCI 00465966 PAGE 2 OF 2 03 ARRESTED 20110631 AGENCY: IA0520200 IOWA CITY PO CHARGE NO- 01 IA STATUTE IA708.2A(2)(C) DOMESTIC ABUSE ASSAULT /INTENT OR DISPLAYS A WEAPON TRK#: 1A00CM401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTAL ILLNESS COURT CASE ID: 06521 AOCRO95394 CHARGE CLASS: NON CONVICTION TRK#: 1AOOCM401 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20120403 FINE $315 20120403 PROBATION lY 20120403 DISCHARGED PROM 20130228 DEFERRED JUDGEMENT 04 ARRESTED 20150901 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708,2A(2)(C) DOMESTIC ABUSE ASSAULT W/INTENT OR DISPLAYS A WEAPON TRK#: 1A00LHD01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2A(2)(A) DOMBSTIC ABUSE ASSAULT- IST OFFENSE Resident Household Member COURT CASE 1D; 06521 AGCR109512 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A00LHD01 SENTENCE DISP EFF DAT TIME SERVED 2D 20151204 JAIL 213 20151204 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 POSXTIVE 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 Nov,21, 2016 9:29AM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY No.8520 P. 2/3 DCI 00465966 PAGE 1 OF 2 DATE PRINTED - 2016/11/21 DCI:00465966 NAME: PEARL,ANDREW ASTRO SARGENT,ANDREW SERGENT,ANDREW DOB SEX RAC HGT WGT EYE HAIR SKN 19611110 M W 510 190 BLU BRO FAR ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD 1*1 01 ARRESTED 19930722 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA712-5 RECKLESS USE OF EXPLOSIVES _ '14 Z S w TRK#: 000730601 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA712-5 RECKLESS USE OF EXPLOSIVES COURT CASE ID: SR35664 CHARGE CLASS: NON CONVICTION TRK#: 000736601 POB IA SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19940103 COURT COSTS 19940103 PROBATION 2Y 19940103 COMMUNITY SERVICE 50H 19940103 DISCHARGED FROM 19951223 DEFERRED JUDGEMENT 02 ARRESTED 20050214 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- OL IA STATUTE IA321J.2 OPERATING WHILE INTOXICATED TRK#: 101437301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WE INT (OWI) / IST OFFENSE COURT CASE ID: 06521 OWCRO71502 CHARGE CLASS: NON CONVICTION TRK#: 101437301 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20050713 20060113 PROBATION 365D 20050713 DISCHARGED FROM 20060719 . DEFERRED JUDGEMENT r•