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Home My WebLink About17-041IDENTIFICATION NO./ —7—D (4 I l 1 (Office Use Only) 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" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) First 3. Contact Information (REQUIRED) Email: i'Lhr?i; 'Gre4 k100X ' Cell Phone: 3/1 (All writt n commurycation sent via em W 4a. Driver's License expiration date (REQUIRED)�> 7 Z 12 1 b. Taxicab Business Name (REQUIRED) 7 ALL 6 1, e,4 6 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 What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedi Plead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the wears? l� Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? Iftyej, please *vide the name(s) _?��I I�JTI tti•.1 b DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOP -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 A ZL9 \C X S f :% 0) issued on 12 expiring on `R2 j (�4. 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 Appli ori_ ---__=77;--� Date 3 44 ff+lfflmmfHfllf»111!1»11!11»ffm»f»rmf f«1f:f 11fm»m1f»f»fflmflmmlfff»+f»+:f»f»1111!»»1f»»»»fmf:f f of lmafff STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Err- C. on this 43 day of .......f..f...».fHH»mfff»1f».+f»....1f ...............»..f...Hf»f»fff» ..H 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 D$ - 43 • ?.O l i Signature of P lice Chief or designee 0Z_/3!20)7 Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MO THAN ONE YEAR FROM THE DATE LISTED BELOW. MT ?/W) Signature of City Clerk or designee Date Hmf»»»Hf»lffm»1111ff11ff1fflfff f f f 1fmHHH1H»flmf f 1f»f»fnmf f f ffmHfflfYfHHHHHfMhf»11fl1fYflf 11»lffffly11f1fm Office Use Only Approved application DCI report State certified driving record Website update t ;o :� Ilad s i a�� Fiat 0 -1IA Ci MJn XIDRN64DCEAPPLg20l9 .m dW.DOC 07/2016 C410WADOT ,NwwioW8dot SMARTER I SIMPLER I CUSTOMER DRIVEN 9� Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515.244-91241 BOD -532-11211 Fax: 515-239-1837 www.bwadot.gov Certified Abstract of Driving Record Inquiry Date: 3/8/2017 DL/ID #: 428XX5189 (IA) CDL Permit Class: None Customer #: 4327574 Class: D CDL Permit Issue None Date: Name: Fowler, Eric Dean Audit #: 6310503 CDL Permit None Expiration Date: Address: 122 1/2 N DEVOE ST Issue Date: 09/18/2012 CDL Permit None Endorsements: Expiration Date: 08/23/2017 CDL Permit None Restrictions: City/Stab: LONE TREE, IA 527557742 Endorsements: 2 ID Status: None Mailing PO BOX 33 Restrictions: Corrective Lenses, Left and DL Status: VAL Adder: Right Outside Minors Restriction None CDL Status: None Mailing LONE TREE, IA 527550033 Supplement: CDL Permit Status: ELG city/Stab: Data of Birth: 8/23/1973 CDL Cert Status: None Sax: M CDL Med Status: None History Information Convictions "Ltation Date Conviction Date ACD Explanation County JUR L3/02/2012 111/15/2012 '592 lSpeed (10 mph @under In 35-55 mph zone) Muscatine ;LA Name: Fowler, Eric Dean DL/ID: 428XX5189 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 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: 3Yk 11 et03 ./�44 3/8/2017 IOWA �h"'AF ...VE9 Office of Driver Services �.......-- Iowa Department of Transportation Name: Fowler, Eric Dean DL/ID: 428XX5189 8v" LIU Mar. Iv. [oil i:4[riv, ulv 0 (.riminaI lnvestlgation No. h2§4 P. 1/1 FrO..,.....y ... ....re... ._..y Inrk 03/02/2017 10:3, ....87 .—. ,002 STATE OF IOWA Criminal History Record Check Request ]Form J DCI Account Number: 4_L -C.0 — F (if applicable) 'ro: Iowa Division of Criminal Investigation Frolo:_ Cify of Iowa Support operations Bureau, V Floor City Clerk's Office ~� 215 C. 7" Street 410 F. Washington Street Des Moines, Iowa 50319 �_7a, ! 6066 !2wn�'lry,1A 427a0 (515) 71.5-6080 Fox -- Phone; 319-356-5041 Fax: 319-356-5497 I ant reauestine an Iowa Criminal 14istmv Record Cheek nn - Last Name (nnoalo0) First Nan1e (mandatory) 114id die Name (raeonlnicoded) JL' tc�lrr `. Try J'h� -- Date of Birth (snm,dalo y) Gender (nandalory) Social Security Number (recommended) gl *male ❑Female `5 3 to J Wrtiver Information; Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of lows, Chopler 692.2, For complete criminal history record information, as allowed by law, always obtain a waiver signature from the sub ect of the request. Waiver Release: I Isoraby, give pemtlssion for tae above requeslsnyyjtei conduct an Iowa criminal hlslory mord check ehh d e Dlvlsion of Criminal Invutigslion (a0. Any aintinol history dais conccmitI mtlNatis'Miinlein11 by lh DCI my be released as allowed by law. ... /71 Waiver Signature. ._. ............. /.c', ltll' - Iowa Criminal history Record Check Results (Del vsc only) As of 1- P- Q a search of the provided name and date of birll7 revealed: No Iowa Criminal Aistol)' Record fouled with DCI ❑ Iowa Criminal History Record attached, DCI ii� DCT initials__ a - DCI -77 (08/25/10) Received Time Mar, 9. 2017 9:16AM @o.5096