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Home My WebLink About17-007IDENTIFICATION NO. n—DD--1 1 r 1 (Office Use Only) �Ir"III APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (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" infonnation will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First, Middle I Last ,n 1. Name (REQUIRED) 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 1Y/`/ /2/tZOz / b. Taxicab Business Name (REQUIRED) —rte I �01/v C a Q p Q' -,IC L 5. Prior experience in transportation of passengers: C A Cell Phone: b.3 °' /90 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? YeT 7 What happened to the charge? (Circle one) Convicted Dismissed erre Suspended Plead Guil Other Have you been arrested/ charged with any traffic offenses in the last five years? S TvDe of offense Wher When 2 fpef lltv P goa r r What happened to the charge? (Circle ane) 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? Type of offense Where When 9. Have yoy 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 r FAPPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa De artment of Transportation a valid Driver's license number Z5,) M (� 15-2— issued on �� expiring on /2 2,rZI . 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 —o tz 7- STATEATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by "f LAc ,.� S D _ L — on this % Z day of La1fdCl/ 7Dl-1 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 )i Z 2b2 24 Signature of Police Chiefor designee / &:L1 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. Signatuit of City Clerk or designee J Office Use Only Approved application DCI report State certified driving record Website update 11 Date CIeMnT IDRIVBADGEAWL92014amended.DOC 07/2016 CiJIUWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN Vvww,iowadot.gov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 18011-532-111211 Fax: 515-239-1837 www.iowadot.gov Inquiry 1/10/2017 Date: Customer 4289265 Name: Bane, Thomas Daniel Certified Abstract of Driving Record DL/ID #: 251CCO152 (IA) CDL Permit Class: None Class: D Audit #: 9689750 Address: 5038 AMERICAN LEGION Issue Date: 01/06/2016 RD SE Expiration 01/12/2021 Date: City/State: IOWA CITY, IA Endorsements: 3 History Information Convictions CDL Permit Issue None Date: CDL Permit 522409070 Mailing 5038 AMERICAN LEGION Restrictions: Corrective Lenses Address: RD SE Restriction None Mailing IOWA CITY, IA Supplement: City/State: 522409070 Date of 1/12/1969 Birth: None Sex: M History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: 09/13/2012 CDL Permit None Restrictions: IA ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: 09/13/2012 CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County ]OR D8/13/2012 09/13/2012 S92 Speed Johnson IA 12/10/2012 01/11/2013 M14 Fail to Obey Traffic Sign/Signal Johnson IA DS/08/2016 06/13/2016 S93 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]OR ' 07/15/2012 695214 IA 10/11/2014 821287 IA 11/07/2014 825843 IA Name: Bane, Thomas Daniel DL/ID: 251CCO152 Pursuant to Iowa Code 4321.10, 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: Jan. 5, 2017 8:57AM Div of Criminal Investigation No -0628 P. Fwm:�.,ry lir '.vv. '.,v olerw vii iav ..—------- 01/03/2017 17:41 77ea .....2/002 �. STATE OF IOWA �. Criminal History Record Check i f Request Form ''ut�,wss3' DCI Account Number: 9967-F — Iif Applicable) To: Iowa Division or Criminal Investigation Prom: _ Yellow Cab of Iowa City Support Operations Bureau, I" Floor P.Q. Box 428 215 E. 7" Street Des Moines, Iowa 50319 _ _ .Iowo.Clty., iA�52244 (515)715-6666 (515)725-6080 Fax (319)338-9777 Phone: Fax: (319) 339-7302 I em regUeSdriR an Iowa Criminal Histo Record Clteclt on: Last Nanle (mandslary) First Name (mandatory) Middle Name (recommeimded) aniQ Date of Birth (mandatory) Gender (mandatory) 'Soclall-SecurityNuumbex (recommendod) iP N1 �ale ❑Female y l rid Ll �" 1GtP Waiver/nj0PMafion: Without a signed waiver from the subject of the request, a complete criminal history record may not l be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed by law, always obtain a waiver sianalure from the sdbiect or the reoue.ct. Walver Release; I hcrtby give permission far the above regeeslloIt omciat to conduct on Iowa criminal his lory record chock with the Division ofCrirninal Investigation (DCO. Any criminal h;vory data coneeming me that is maintained by the DCI may be released as allowed by low. Waiver Iowa Criminal History Record Check Results I (DCI use only) As of J –1 1 a search of the provided name and date of birth revealed; ❑ No Iowa Criminal History Record found with DCI [� Iowa Criminal History Record attached, DCI #_ _':� 117'7 5 DCI initials - DCI - 77 (09/25/10) Received Time Jan, 3. 2017 4:27PM No - 0891 Jan. 5.• 2017 8:57AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00370225 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2017/01/05 DCI:00370225 NAME: BANE,THOMAS DANIEL BANE,TOM DOB SEX RAC HGT WGT EYE HAIR SKN POB 19690112 M W 511 175 BRO BLK PAR IA ADDITIONAL IDENTIFIERS CCH RECORD ••• 01 ARRESTED 19871227 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L33479301 CHARGE NO- 02 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK#: L33479302 CHARGE NO- 03 IA STATUTE IA723-4-1 DISORDERLY CONDUCT TRK#: L33479303 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSDMPTION / INTOXICATION - 1970 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479301 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 PINE $25 19871227 COURT COSTS $20 19071227 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33419302 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $10 19071227 COURT COSTS $20 19$71227 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA723.4(1) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479303 SENTENCE DISP EFF DAT PLEAD GUILTY 19071227 FINE $10 19871227 No. 0628 P. 2/5 Jan. 5: 2017 8:57AM Div of Criminal Investigation COURT COSTS $20 02 ARRESTED 19090507 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 XA STATUTE IA123-46 PUBLIC INTOX TRK#: L33479401 CHARGE NO- 02 IA STATUTE IA714-2-5 THEFT 5TH DEGREE TRK#: L33479402 CHARGE NO- 03 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK#: L33479403 COURT DISPOSITION AGENCY: IA05201SU JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRE#: L33479401 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714.2(5) THEFT STH DEGREE - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479402 SENTENCE PLEAD GUILTY FINE $75 COURT COSTS $20 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS CHARGE CLASSi MISDEMEANOR CONVICTION TRK#: L33479403 SENTENCE PLEAD GUILTY FINE $15 COURT COSTS $20 03 ARRESTED 19910607 AGENCY: IA0520200 IOWA CXTY PD CHARGE NO- 01 IA STATUTE IA321J-2 OCI 00370225 PAGE 2 OF 4 19871227 DXSP EFF DAT 19890508 19890508 19890508 DISP EFF DAT 19890627 19890627 19890627 No. 0628 P. 3/5 An. 5. 2011 8:57AM Div of Criminal Investigation ONI TRK#: L33479501 CHARGE NO- 02 IA STATUTE IA204-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: L33479502 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA204.401(3)(13: POSSESSION OF MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479501 SENTENCE JAIL 1D CREDIT N/TIME SERVED 7H COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321J-2 OWI CHARGE CLASS: NON CONVICTION TRK#: L33479502 SENTENCE DEFERRED JUDGEMENT DISCHARGED FROM DEFERRED JUDGEMENT 04 ARRESTED 19950226 AGENCY: XA0520100 CHARGE NO- 01 POSSESSION-SCH I TRK#: 014619101 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 CORALVILLE PD IA STATUTE IA124-401 JOHNSON CO DIST COURT IA STATUTE: IA124-204-4-M POSSESS MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014619101 SUBSTANCE ABUSE EVALUATION SENTENCE SUSPENDED JAIL 30D FINE $250 COURT COSTS $75 PROBATION lY COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA665-4(2) CONTEMPT OF COURT CHARGE CLASS: MISDEMEANOR CONVICTION DCI 00370225 PAGE 3 OF 4 DISP EFP DAT 19910826 19910826 DISP EFF DAT 19910926 19920820 DISP EFF DAT 19950330 19950330 19950330 19950330 No -0628 P. 4/5 Jan. 5. 2017 8:57AM Div of Criminal Investigation TRK#: 014619102 SENTENCE JAIL 5D DCT 00370225 PAGE 4 OF 4 DISP EFF DAT 19980915 No.0628 P. 5/5 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, 9UREAU 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 %