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Home My WebLink About16-274+ ylrl®rill CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1 82 6 (3 19) 356-5040 (3 19) 3S6-5497 FAX 1. Name (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 First 2. Address (REQUIRED) a sl 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQL b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa Middle (All written communication gent via email) Last If t-� saa o Cell Phone: 3 (q q `l9 741YO 0 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State orelseRiere?_,r,( n M T eofoffens1e� Og95� Where n 14_11 enw —^ 3 /+i7s emay„o7S y+on, l C�.VLpf ,' gs9cry /-f haio45.n¢nf PAAlsn .,ylDi75oniit;" 4P r rut 1 ,ra.to.4,. '/I 19 9 g What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspende Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? Ie -s Type of offense t,- , /Ofe, 4'o 9 be What happened to the charge? (Circle one) Where II II ''� 1 When Convicted Dismissed Deferred Suspended Plead Guil Other ^ / 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Lyo Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 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 cert' that I have issued to me by the Iowa Depqtment of Transportation a valid Driver's license number %Co y7o19ss issued on 2 / expiring on q 0/ 22. . 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, anti i fi . hor agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provis? i 90 ^41hP City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant, (i�`4�� Dates_ STATE OF IOWA6--- COUNTY OF JOHNSON Subscribed and sworn to before me by Y o�tg�' 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 thgEity q Iowa City (Title 5, Chapter 2, City Code). license N//( ' 22 Ll Z7/lI 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 re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date OwkrrMIDRNBADGEAPPL9201"m&ldetl.DOC 07/2016 410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www,iowadotgov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 12/15/2016 DL/ID #: 769YY2955 (IA) CDL Permit Class: None Customer #: 2349835 Class: D CDL Permit Issue Date: None Name: Hamrick, Chadwick Aaron Audit #: 7661903 CDL Permit Expiration None Date: Address: 2518 INDIGO DR Issue Date: 01/02/2014 CDL Permit None Endorsements: Expiration Date: 04/11/2022 CDL Permit Restrictions: None City/State: IOWA CITY, IA 522406808 Endorsements: 3 ID Status: None Mailing Address: 2518 INDIGO DR Restrictions: NONE OL Status: VAL Restriction None CDL Status: None Mailing IOWA CITY, IA 522406808 Supplement: CDL Permit Status: ELG City/state: Date of Birth: 4/11/1977 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions :Ration Date Conviction Date ACD Explanation County JUR ]ohnson IA 11/05/2015 02/03/2015 M14 Fall to Obey Traffic Sign/Signal , Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. tccident Date Case Number 3UR )6/07/2014 802293 ]A _. 18/20/2014 1.813321 JA Name: Hamrick, Chadwick Aaron DL/ID: 769W2955 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 1 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: F Vr IOWA ':s'% 12/15/2016 ........ BNE� S� OR Office of Driver Services Iowa Department of Transportation Name: Hamrick, Chadwick Aaron DL/ID: 769W2955 uec,L3. z u i u 4:IJrivi u i v o brlminaI lnvesiigation vo,9U4L r. I/I Fr_.... _.-- _. ._v._ _.., Cl.,.. _...__ ,-,-,------ I 12/21/,2016 10:2- -764 STATEA OF IOWA Crrbminal 11 istary Record Ci>eck Request Form DClAccountNumber: To: IOWA Division ofC:yitninal Investigation Support Operations Wireau, It/ Floor 21.5 E, ?'h 5(reet Res Moines, Iowa 50319 (515)725-6066 _ (515) 725-6090 Fax I alas rennestirro An Tntva ("'riminnt .,. Prom: City of Iowa City___ _•SSSS_ City Clerlt's Office 410 G. Washington Street Iawa Clty, IA 52240 Phone; 319-356-5041 Fax: 319-3,56-5497 ��--- Last Name (mandatory) First Nanle (mandelop) Middle Name (recommended) 1�,�, c; % ["�� Date of Birth (mandatory) Gender (mandatory) $Social Seeare Number (recmumendcd) - /Y, 7,7 c16 5 Waiver Informalfom7 'Without a signed waiver from the subJeet of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For coco^mnlete criminal history record Information, as allowed by (ave, always obtain a waiversienoture tram the subject of (he request Walver Release; t hcreby give pOrnsissian forme above requesl'og official to conduct an Iowa criminhl history sewrd check wdrn die Division ofGiminal Invesligatioo (001), Any u nttoal history data concerning mal rain(ans y the p/�y r elsleased as allow• it bylaw. ' WaiverS'igraalut'e,_ Iowa Criminal ffistor r Record Check Results As of 11�i l 1. a search of the provided name and dale of birth revealed ® No Iowa Criminal Aistory Record found with DCI W lotva Criminal History Record attached, DCI #�— o 2b V DCI initials_ 1rW-II tU0/L]/lu) Received Time Dec, 21. 2016 9:05AM Nlo, 0322 (DC) use mdy) U r J Ile c, 13. 2u 16 4:IjVIA Div of criminal Investigation No,uu4[ r, z1 IOWA CRIMINAL HISTORY DCI 00507646 FELONY CONVICTION PAGE 1 OF 1 DATE PRINTED - 2016/12/23 DCI:00507646 NAME: HAMRXCK,CHAD HAMRICK,CHADWICK AARON DOB SEX RAC HGT WGT EYE HAIR SKN POB 19770411 M W 508 165 BRO BLK LGT IA ADDITIONAL IDENTIFIERS CCH RECORD w*■ 01 ARRESTED 19950916 AGENCY: IA0920000 WASHINGTON CO 50 CHARGE NO- 02 IA STATUTE IA708-7 HARASSMENT TRK#: 022450902 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 02 IA STATUTE: IA708-7 HARASSMENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 022450902 SENTENCE DISP EFF DAT FINE $100 19961024 02 ARRESTED 19980902 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA713-6 ATTEMPT BURGLARY 2ND DEG TRK#: 037241001 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA713-6(2) ATTEMPT BURGLARY 2ND DEG CHARGE CLASS: FELONY CONVICTION TRK#: 037241001 SENTENCE DISP EFF DAT COURT COSTS 19990226 PROBATION 2Y 19990226 SUSPENDED 5Y 19990226 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 POBLIC 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