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Home My WebLink About17-001CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1 82 6 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. I Z —(Ib i (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 2. Address (REQUIRED) 1 o 3 r 3. Contact Information (REQUIRED) Email Cell Phone: Z19- 3 3 t 7ySk (All written communlcat.— o,ii via email) 4a. Driver's License expiration date (REQUIRED) 9— 12 b. Taxicab Business Name (REQUIRED) 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? e -r Tvoe of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil Other Have you been arrested / charged with any traffic offenses in the last five years? ,1�:� L/ /_ Type of offense Where When What happened to the charge? (Circle one) on ed 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? Iff z9 Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the h me(tp -" DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CEgTIF1rzD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REWEW 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 hay y�sued to me by the Iowa Department of Transportation a valid Driver's license number D % S� /_ p) issued on � —� —/Nexpiring on 9` 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, Chapte ,oft City Cpde. (Needs to be signed in front of a Notary Public) Signature of Applicant Date d 3 — � 7 STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by M M-rK /k . in -P ler on this 3 day of Lfu _r-0lZ _ S. MAYER WNW 72542e Notary Publ in and 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). 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. Sign f City Clark or designees Office Use Only 1�l Date Approved application ja.9 DCI report :_3 ��„ State certified driving record = ca~ Website update ra 'rn, s- Gedc/TAXIDRNBADGEAPPL92014amended.DOC �..{ 07/2016 a u C4JIOWADOT vvvvw.iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Oriver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 www.iowadol.gov History Information Convictions Citation Date Conviction Date ACD Explanation County IUR 10/07/2012 11/05/2012 S92 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number Certified Abstract of Driving Record 01/18/2009 Inquiry 12/28/2016 DL/ID #: 075AA0689 (IA) CDL Permit Class: None Date: IAZ Customer 1683236 Class: D CDL Permit Issue None #: Date: Name: Meier, Mark Allan Audit #: 8410628 CDL Permit None Expiration Date: Address: 1129 HOTZ AVE Issue Date: 09/03/2014 CDL Permit None Endorsements: Expiration 09/18/2020 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: None 522453319 Mailing 1129 HOTZ AVE Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522453319 Status: Date of 9/18/1954 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County IUR 10/07/2012 11/05/2012 S92 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 01/18/2009 '.500760 IA 03/12/2013 730061 IAo', 09/13/2014 816583 IAZ Name: Meier, Mark Allan DL/ID: 075AA0689 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa DepartdlMtpf TMsportitioM, 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-Departrilent 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: Name: Meier, Mark Allan DL/ID: 075AA0689 �••""""• :'e7 11 12/28/2016 IOWA `f� D. 0. T...-* ;°-* iF•DB�VEA S Office of Driver Services Iowa Department of Transportation !ii UeC.2tl. 2U16 2:IdFM Uiv of Criminal Investigation No. 021h N. 1/11 Pr.,r,:Cley of low. City Clerk Orrloa 310 3666497 12/27/2016 09:38 0760 P.002/002 STAT GFI VVA "? Criatitlatl History Recoy d Check Request Form Teti Iowa Divition ofcriminal Invettigation Support Operations Bureau, 1" Floor 215 F. 1n' Street Des Moium, Iowa 50319 (515)725.6066 — (515) 725-6080 Fax I am ranaeNine, an Tmua Liminal MuniV Renard Check on, DCI Aceotn t Number:— (irapplicable) Fropa: City of Iowa Cily City Cit ilt'S Off -ice----- - 410 13. Washington Strect Iowa Cii IA 52240 Phone: 319-356-5041 Fax: 319.356.5497 Last Name (n,andatoq•) First Name (Inandatog) Middle Name (rownmundad) Diteeof Bit th (maoeato ) Gender (ni ndaloo) Social Security Number (reeommendad) 9— — y Omale ❑Female y,P�2- FMaiver information: Without a signed waiver from the subject of the request, a complete criminal history record may not he releasable, per Code of lows, Chapter 692.2. For complete criminal his(ory record information, as allowed by law, always obtain a waiver signature from the subject of the request. Waiver Release: l hereby give peonissioa for rhe above manestingoKcial to Whdecl M Iowa criminal histaty record check with the Division of Crinsinal Investigalion (OCT). Any criminal histay data Oneerning me that is maimained by the DO may be released as allowed by Isw. Waiver Signature: Iowa Criminal History Record Check Results (000 use ani) As of �— , a search of the provided name and date of birth revealed:' ci w ® No Iowa Criminal History Record found with DCl OK Iowa Criminal Histury Record attached, DCI #.�� cl DC1 mitiols��_ DCII -77 (06/25/10) Rrriivod Timi Dir 71 9016 U UM Nn_05I5 Uec.ib- 2U Ib 2: IdYNI U i v of Grlminal Investigation No. 0215 Y. 2/11 IOWA CRIMINAL HISTORY DCI 00189118 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2016/12/28 DCI:00189118 NAME: MEIER,MARK ALAN MEIER,MARK ALLEN DOB SEX RAC HGT WGT EYE HAIR SKN POB 19540918 M W 511 200 BRO BRO MED IA ADDITIONAL IDENTIFIERS GLASSES SC L KNEE SC R KNEE CCH RECORD *** 01 ARRESTED 19730306 AGENCY: IA0820200 DAVENPORT PD CHARGE NO- 01 DELIVER MARIJUANA TRK#: 1,07626701 COURT DISPOSITION AGENCY: IA082DISJ SCOTT CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(3) CONTROLLED SUBSTANCE / POSSESSION/MARIJUANA - 1993 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1,07626701 SENTENCE DISP EFP DAT SUSPENDED JAIL 6M 19731030 PROBATION 19731030 02 ARRESTED 19910507 AGENCY: XA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L07626801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STAIUTE: IA321J.2 OPER VEH WE INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRW L07626801 -, SENTENCE DISP EPP DAT JAIL 2D 19910627 J FINE $500 19910627 CREDIT W/TIME SERVED 7H 19910627 � 4 cp W 03 ARRESTED 19951111 mS AGENCY: IA0520200 IOWA CITY PD a7 CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRH#: 022560101 W COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT Uec. iC. ZUIb 2: 1WM U i v of Criminal Investigation DCI 00109118 PAGE 2 OF 2 No. 0215 P. 3/11 COUNT NO- 01 IA STATUTE: IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 022560101 SENTENCE DISP EFF DAT JAIL 7D 19960221 FINE $750 19960221 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 cc."