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Home My WebLink About16-265�r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 13 19) 356-5497 FAX 1. Name (REQUIRED) ! 2. Address (REQUIRED) 3. Contact Information (R IDENTIFICATION NO.11Q— Z_ &LL (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 u 4a. Driver's License expiration date (REQUIRED) iQ - 3 0 - a-3 b. Taxicab Business Name (REQUIRED) 11 Q (( 0W C Q 121 Vo (fee.4 Men o4 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense / Where When b1r r('u5Srt.reri -31K�{ �IP[,rc4 7ou,a -0CU`7 What happened to the charge? (Circle one) Convicted Dismissedeoffensn Suspended Plead Guilty Other �t ne 7. Have you been arrested / charged with any traffic the lastfive years? T voeof offense Where When 3 C�A+(fo (e 5� A C¢ —� 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? AW yr' 5 _Type of offense Where When e r\6, 9. �J 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please afovide th&7name1 t DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE'CERTJFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form availableLpon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I her by certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 1 C G O 3 a- i issued on `y-16' /b expiring on (D-30 1 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 0-D �,e'^ Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this �day of 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). date of,91'Wr's license or of 2 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. Sig yature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Ger✓rAXIDRIVRADGEA Pl92014ame ded.DOC ate 07/2016 ti r -� rn Ti 07/2016 C410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN vuwuv1°wado gov Office of Driver Services PO Box 9204 1 Des Moines. IA 50306-9204 Phone: 515-2449124 1800-532-1121 1 Fax: 515-239-1837 www.lowadat.gov Inquiry Date: Customer Name: 8/12/2016 4643734 Certified Abstract of Driving Record DL/ID #: 251CC0327(IA) CDL Permit Class: None Class: C Brown, Clarence Anton Audit #: 1183054 Address: 425 KOSER AVE City/State: IOWA CITY, IA 522463040 Mailing 425 KOSER AVE Address: Mailing IOWA CITY, IA City/State: 522463040 Date of 10/30/1969 Birth: Sex: M Convictions Issue Date: 07/27/2016 Expiration 10/30/2023 Date: Endorsements: NONE CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit CDL Permit None Restrictions: IA ID Status: VAL Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG No Driver's License Status: IA L2/18/2013 CDL Cert Status: None History Information CDL Med Status: None :itation Date Conviction Date ACD Explanation County JUR )1/02/2013 02/12/2013 B51 No Driver's License Johnson IA L2/18/2013 01/17/2014 B20 Driving While Suspended, Denied, Cancelled, Revoked Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR 3UR Suspended 05/06/2014 03/08/2016 D53 Non -Payment of Iowa Fine IA IA Name: Brown, Clarence Anton DL/ID: 251CCO327 lJ Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Tr�nsporttatI''g�n, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is;a true and;accuratdacppy of an official record currently in the custody of said office, and that I have been authorized by the Direc0rrof 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: �o0e- 7 :apj� 8/12/2016 IOWA '� cl'1®f RRNEB s Iowa Office of a Departme tiver Services lTransportation cle/Aug. 24. 2016512:20PMcebDiv of Criminal Investigation (FAX)3193380o.1436 STATE OF 0 Criminal History'. 'ec:rAdChe ri �h:11G.57"j it I RequesiPorm Tot Iowa Division of Criminal Investigation $upport Opo rations Bureau, 1" Floor 2151;, 7'h$treat Dos Molnes, Iowa 50319 (515)725.6066 (515) 725.6080 Pax Tarn rwn„nctina an TnWA r..riminxl Mktnm; Record Meek nn! P. 1/3/002 DCl Account Number: 9967-F r ' �(Itepplleeble) From; Yellow Cab of lows CI P.O. Box 428 . Xowa City, XA, 57244 (319) 938.9777 Phone: Fax: (319) 33P.7302 Lost Norse mendno First Name mandato 1Viiddle Name (reecmrn/wild) (0wn c) a reei Ce- 4n4 -on Date of Birth mindelop Gend,_er%andamry -So glal•Securi Number (rowmmcnded to '� 'b J„ mm/aIe ❑Female 3� ? ~ —7 6 3 t Waiver Information: Without a signed walvor from the subject of the request, a complete criminal history record may not be releasable, per Code orrowa, Chapter 692.2. For comolota criminal history record Information, all allowed by law, always blain a welver sign MUM frIn the sub ect of the ro uast, Waiver Released hetoby give pormisllon renhe above requa,ling oaialel le eenducl an town oriminal b(storyrowrd cheek v(IW the Dlvleton otCrlminel Invesilgelton(DC]),. Any enalinsi history dalellne That is maintained by the�may be released as allowed bylaw. Waiver S►gnaluret �•�"'-�— ' .'� Iowa Criminal History Rqgqrd Check Results _ (ocl see only) i•N J As of 21 a A a search of the provided name and date of birth revoeled: ❑ No Iowa Criminal History Record found with DCI , 0 `1P Iowa Criminal Mstmy Record attached, DCI 9—an-3-6-1 0 DCI lnitials DCI.77 (08125110) Received Time Aug. 19. 2016 12:10PM No. 1073 Aug.24. 2016 12:20PM Div of Criminal Investigation IOWA CRIMINAL HISTORY NISDENRANOR CONVICTIONS ONLY DCI 00818366 PAGE 1 OF 2 DATE PRINTED - 2016/08/24 DCI:00818366 NAME: BROWN,CLARENCE ANTHONY DOB SEX RAC HOT WGT EYE HAIR SKN POB 19691030 M E 5I0 225 SRO ELK DRK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT R SHLD CCH RECORD *** 01 ARRESTED 20071027 AGENCY: IA0520100 CORALVILLE PD O CHARGE NO- 01 IA STATUTE IA708.7(4) °rri HARASSMENT / 3RD DEG. - 1989 TRK#: IA002NZ01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.7(4) tV HARASSMENT / 3RD DEG. - 1989 tr COURT CASE ID: 06521 SMSM067566 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: lAO02NZOI SENTENCE DISP EFF DAT FINE $100 20071028 02 ARRESTED 20080924 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 03 IA STATUTE IA726.6(7) ENDANGERMENT/NO INJURY TRK#: SA0057FO3 CHARGE NO- 04 IA STATUTE IA124.401(1)(0) CONTROLLED SUBSTANCS VIOL. TRK#: 1A0057FO4 COURT DISPOSITION AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(1)(B; CONTROLLED SUBSTANCE VIOL, COURT CASE ID: 06521 PECROB4831 CHARGE CLASS: NON CONVICTION TRK#: lAO057POI SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $1000 CIVIL PENALTY 20090529 PROBATION 3Y 20090529 DISCHARGED PROM 20150511 DEFERRED JUDGEMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 04 IA STATUTE: IA726.6(7) CHILD ENDANGERMENT/NO INJURY No.1436 P. 2/3 :v 0 O rn C ) °rri tV tr Aug. 24. 2016 12:20PM Div of Criminal Investigation No. 1436 P. 3/3 DCI 00918366 PAGE 2 OF '2 COURT CASE ID: 06521 FECR084811 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0057F04 SENTENCE DISP EFF DAT SUSPENDED JAIL 1651) 20090529 JAIL 190D 20090529 FINE $625 20090529 PROBATION 2Y 20090529 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRJ-gINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OP 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 �c o O v'.