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Home My WebLink About17-010� r 1 �1 -did i �III� ._ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3191356-5040 (319)356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. j -1— OCD (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 3. Contact Information (REQUIRED) Email: Cell Phone: S�'%77-9G f? (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED)._ 5. Prior of 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspende Plead Guilty her Have you been arrested / charged with any traffic offenses in the last five years? d Type of offense What happened to the charge? (Circle one) Where When X44 24' 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 G V 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pdrvide tW 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 certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 4 8 ine-VI",?geo issued on zv?xpiring on 20 7. I understand that if I falsely answer any questions in this application, that this aplicatfon may be denied. f agr6e that in making this application, 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 1 further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of T/e/5 Chapter 2 the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican/Date — f -2b/ 7 fHlMHHHHHHfIflllf4ltff\\1f!!1!!1fllifhfHH11H11lHfflflf-f1HHHHHH1fl11f!!!f\fr!\\H1HHl1!\ft1H11nlllfff!\\HH\fYf\\l1Ykf fflff STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by %er 6LA F�2u on this � day of `foy.ua f d Z01-7. 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,CityCode). / Expiration date of Driver's license 3 / J ►��I AA c Signature of Police Chief lef 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 f City Clerk or de ignee Office Use Only _ N _ Cn Approved application DCI report State certified driving record r Website update 0 OerWrAXIDRIVBADGEAPPL920148m dW.DOC 07/2016 Pagel of 2 0401 A DST M www,iowadogov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www.iowadolgov Certified Abstract of Driving Record Inquiry 1/19/2017 DL/ID #: 808NN2900 (IA) CDL Permit Class: None Date: 12/13/1997 11/21/2016 D53 Non -Payment of Iowa Fine IA Customer 5057204 Class: D CDL Permit Issue None #: Date: Name: Bell, Keith Harold Audit #: 1558180 CDL Permit None Expiration Date: Address: 914 20TH AVENUE PL Issue Date: 01/19/2017 CDL Permit None APT 10 Endorsements: Expiration 03/31/2022 CDL Permit None Date: Restrictions: City/State: CORALVILLE, IA Endorsements: 3 ID Status: EXP 522411420 Mailing 914 20TH AVENUE PL Restrictions: NONE DL Status: VAL Address: APT 10 Restriction None CDL Status: None Mailing CORALVILLE, IA Supplement: CDL Permit ELG City/State: 522411420 Status: Date of 3/31/1957 CDL Cert Status: None Birth - Sex: M CDL Med Status: None History Information Sanctions Type Effective End ACD Explanation Occurrence 3UR 3UR Suspended 12/13/1997 11/21/2016 D53 Non -Payment of Iowa Fine IA Suspended 02/20/1998 11/21/2016 D53 Nan -Payment of Iowa Fine IA Name: Bell, Keith Harold DL/ID: 808NN2900 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 aridaicurate 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. `J In witness whereof, I have caused my signature and the seal of the Department to be set upon this document-, ht Ankeny, Iowa this date: • IOWA' 1/19/2017 :4 f Office of Driver Services 1/19/2017 Jan,24. 2011 2:03FM Div of Criminal investigation No.2016 P. 1/3 From:Clly of lewa City Clerk 01(10& 310 SECE497 01/23/2017 10:40 *798 P.002/002 �• Criminal History Record Check Request 'Form 1)CI Account 1Vumber, ,!'i ooLr .� (if appliablc) TO: Iowa Division of Criminal Investigation From: City of lows City Support Qperatirnrs H UVC2O, Is' Floor City Clerk's Off -tee 215 L. 7'e Street 4101. Washington Street Des Moines, Iowa 50319 (NS) 725.606(_ ... _..-_._ Iowa City, jR.53240 (515)725-6080 Fax phone: 319-356-5041 Fax: 319356-5497 I am reouestina an Iowa Criminal Histoiv Record Check on: last Name (mandatory) First Name (mandate y) Middle Name (recommended) -1,14 fv � 10 Date of Birth (mandemry) Genddeer (mandelory) Social Securi q Number (iecmumandcd) -�� - �� ale ❑I+etnale y -7G �j� 7 Il IfIfO)•n206011: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For coal criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request. Waiver Belease:I hereby give permission for Use above requeslingoffidw to wnducr lul Iowa criminal bislmy ruord check mills Un: Division of Criminal Inrelligaliml (DCI). any criminal history data emlcemin• in, n s ismroams by the D be released as allowed by lam. 'I 1 WniverSignnlure:-��K-; _ iv` Iowa Criminal History Record Check Results c,,,,ronly) u, As of �Zb{` �,, a search of the provided name and date of birth revealed: n No Iowa Criminal History Record found with DCI _ r .n Iowa Criminal History Record attached, llCIISL _ DCI initialsb\ _ DCI.77 (08/25110) Received Time Jan. 93- 9017 9:96AM Nn. 109 L;-. :n Jan.24. 2017 2 : 0 3 P M Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00565310 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2017/01/24 DCI:00565310 NAME: BELL,KHITH HAROLD DOB SEX RAC HGT WGT EYE HAIR SKN POB 19570331 M W 604 270 SRO SRO MED IA ADDITIONAL IDENTIFIERS SC CHIN SC FHD SC NECK CCH RECORD *** 01 ARRESTED 19971128 AGENCY: IA0850000 STORY CO SO N CHARGE NO- 01 IA STATUTE IA321J-2 OWI 1ST OFFENSE TRK#: 033596801 V COURT DISPOSITION AGENCY: IA085015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI IST OPP CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 033596801 SENTENCE DISP EFF DAT JAIL 2D 19971205 FINE $500 19971205 COURT COSTS PAY SURCHG 19971205 02 ARRESTED 20020503 AGENCY: IA0850100 AMES PD CHARGE NO- 01 IA STATUTE IA714.2(2) THEPT 4TH DEGREE TRK#: 041242601 COURT DISPOSITION AGENCY: IA085015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(3) THEFT 3RD DEGREE - 1978 COURT CASE ID: 02851 FECR031713 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 041242601 SENTENCE DISP EFP OAT TIME SERVED 57D 20020702 JAIL 57D 20020702 FINE $500 20020702 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 No.2076 P. 2/3 N 0 V j �.A Jan.24, 2011 2:03PM Div of Criminal Investigation COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.1Ulb F. 9/3