The URL can be used to link to this page

Home My WebLink About17-043IDENTIFICATION NO. 1'7 —D %t ,� (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 (3 19) 356-5497 FAX First. Mi`d'dle Last 1. Name (REQUIRED) t vN 1� 1,2i?v ✓ �� 2. Address (REQUIRED) )23y2 c,L (-,2 t �i 3. Contact Information (REQUIRED) Email: kV,,00d,eCell Phone: L56 5`11 051} (All written bommunication sent via email) 4a. Driver's License expiration date (REQUIRED) 1a 1- Z,-1 -201 e) b. Taxicab Business Name (REQUIRED) �U 5. Prior experience in transportation of passengers: T. � B�� ti� d�3� c e-Ca7 low c C-�, tku c,o.,t 2(70 [� - t }oo� lLL 4 ca,s 04 1,C%kp �ac�c I (cc p 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When GMvv1 P, k[a I u. Sgo What happened to the charge? (Circle one) Convicted Dismissed efer d Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? U-p_� Type of offense Where When Convicted Dismissed Deferred Suspended P ad Gu' Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? U 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 name(&) hJ 0 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 herebyqe i t I have issued to me by the Iowa Departmpot of Transportation a valid Driver's license number I1`1 ft e- 1 �5 1 -1) issued on I C) - 16 -IS exoirino on 11 -LM - 2-010. 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 TiI§e 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant __ Date 3 _J+ \ - STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by .5c At !A) on this .Z f day of A A a A f 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 /L 24• 2W9 Signature of F lice Chief or designee 03.2t - 2017 Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEA FROM THE DATE LISTED BELOW. 4 121117 Signature of City Clerk or designee I D to Office Use Only ` R) Approved application �c DCI report r? State certified driving record Website update e.) w Clete,/TAXIDWRADGEAPPL92014a ded.DOC 07/2016 ACIowa Department of Transportation Office d Driver Services (Tall Reel 800.532.1121 PO OW 9204, ties MMM, IA 5030&9204 $15-244x9124 OFA1C 515,238.1931 Certified Abstract of Driving Record Inquiry Date: 3/3/2017 DL/ID #: 139AC1873(IA) Customer #: 3383405 Name: Grau, Scott Robert Class: D ID Status: None Address: 123 1/2 N MAIN ST Audit #: 9501794 DL Status: VAL 06/07/2014 11/19/2014 Issue Date: 10/16/2015 CDL Status: None City/State: ELKADER, IA 52043 Expiration Date: 11/24/2018 CDL Cert Status: None 02/07/2015 06/10/2015 Endorsements: 3 CDL Med Status: None Mailing Address: PO BOX 96 Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 11/24/1955 Mailing ELKADER, IA Sex: M City/State: 520430096 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 12/06/2013 01/08/2014 M14 Fail to Obey Traffic Johnson IA Sign/Signal 06/07/2014 11/19/2014 M14 Fail to Obey Traffic Johnson IA Sign/Signal 02/07/2015 06/10/2015 M14 Fail to Obey Traffic Johnson IA Sign/Signal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/14/2012 703032 IA 08/24/2013 754528 IA 12 06 2013 771266 IA r.:a J _�a Name: Grau, Scott Robert DL/ID: 139AC1873�' Pursuant to Iowa Code 4321.10, 1, 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 lip)wa 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: Q IN 3/3/2017 4.!........ ' IOWA D. 0. T. ? k. �• ��•�r• .ice� Office of Driver Services Iowa Department of Transporation Name: Grau, Scott Robert DL/ID: 139AC1873 rU i La ,.`'Te' I• {moi {� ca Mar.15. 2017 3:14PM Div of Criminal Investigation No,5777 P. 1/5 b3/12/2017 07: 10Yel love Cab of Iowa Clty (FAX)3193382708 P.002/003 STATE OF IOWA %y Criminal History Record Check Request Form DCI A000unt Number: _99674 (If apDllonble) Tel Iowa Division of CrIn lned Investigation From! Yellow Cab orlowa City Support Operations Bureau, 1"•Floor P,C). 13ox 428 215.2, 716 Street Des Moinas, Iowa 50319 Town City, TA. 52244 (515)725-6066 Fax I) 338.9777 Phone: Foxt (319) 339-7302 I am masinStimtr an 16Wn Crimihnl Rietnry RArnrd Chonlr An - Last Name nundarory) First Name (mendalory)' Middle Name (feaomtnendad) GV�aV, I.d-) - Date of Birth (mandam Gender (mandatory) 'Social Securt Number iaeommended I�-2' \~��' Male ❑Female ��' � S`( � �� Waiver fhfarmafion: Without a signed waiver from the subject of the request, is eomplgte criminal history record may not be roloaseble, per Code of Iowa, Chapter 692,2, For complete criminal history -record Information, as allowed bylaw, always obtain a walver sl nature from the subject of the request, Waiver.Release; I hereby give permlhslon [of the above requesting a del to conduct w lows edmlnl history record ohetk widt the Division orCrlminei Invaaga0on (OCI). Anyorlminal history data eoneeming h ma that 'U atncd by the OCl maybe released as allowed by law. Waiver Signature, As of 3 1 S I1 a search.of the provided namo and date of birth revealed: ❑ No Iowa Criminal History Rcoord found with DCI Oj Iowa Criminal History Record attached, DCI 0 e,� I JP� / DCI Initials—Jac-.1- DCI-77 nitials—Jac-.i DCI-77 (06/25/10) D....:..,.A T; — ss.. 19 inti 7. 10Ahs hl� 6901 (pct use only) Ma r. 15. 2017 3:14PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00261899 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2017/03/15 DCI:00261899 NAME: GRAD, SCOTT ROBERT DOB SEX RAC HGT WGT EYE HAIR SKN POB 19551124 M W 601 168 BLU BRO MED IA ADDITIONAL IDENTIFIERS SC BACK No. 5777 P. 2/5 CCH RECORD *" 01 ARRESTED/TAKEN INTO CUSTODY 19800129 AGENCY: IA0770300 DES MOINES PD CHARGE NO- 01 IA STATUTE IA321-281 OMVVI TRK#: L17524201 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE. IA321-281 OMVUI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L17524201 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT PLEAD GUILTY 19800418 PROBATION lY 19800418 DEFERRED SENTENCE lY 19800418 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