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Home My WebLink About17-058IDENTIFICATION NO. 1-7-0SF, • 1 l 1 (Office Use Only) ��®rte,■ -+t.as�_ CITY OF IOWA CITY APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (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 aoplication (319)356-SO40 (319)356-5497 FAX First Middle ast 1. Name (REQUIRED) 5 C hTr1� LT) T 2. Address (REQUIRED) 1fl(k KII�GP�i CofAl Ut1 1A 5-.29 3. Contact Information (REQUIRED) Email:IpmThed0(f�%1011%)flll , (0 n Cell Phone: —3 11 59L) i05 /Z fAll written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 1 Q b. Taxicab Business Name (REQUIRED) TC 0 5,' i k l (7 10 W (---jL 5. Prior experience in transportation of passengers: —2�[ 5 n—t 0 -A 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 1 vpe of offense Where When SR Al 5d 1 a 0 Ij - U S I f 16 V(v )l Vt � 2 900 1 C P Lo s r;it 4 >ree T -�T i K- (on M I 616VOW1199 515irripW A 55A M3IC pre What happened to the charge? (Circle one) ) () V /V r avc5 Convicted Dismissed Deferred Suspended Plead Guilty Othe6 7. Have you been arrested /charged with any traffic offenses in the last five years T Type of offense Where enN �— ori ✓` cv =in - r i[a What happened to the charge? (Circle one) x co w Convicted Dismissed Deferred Suspended Plead Guil � OthP Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 9. Have you 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 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby,c5eyt)fy,tl�at h�ure7��Ssyed to me by the Iowa D artm t of Transportation a v id Driver's license number ``11 VV II �� i bb ' l(Pp issued on 0 I expiring on I understand that 9 1 falsely answer any questions in this application, that this apply be denied. I a ree 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 appl' tion and u e agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions f S ap r 2 of the City Code. (Needs to be /I srri/g''ned+ in front of a Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) CC r / bscribed and sworn to before me by J�r r' on this "�`' day of KELLt�K Number 22 Bt9 Notary Public in and fo42 State of Iowa Y .....+x.+xx�.ee...+«:..+.nx�.x+++++++++++++:ts, .av,.�v,.raa�wM,�,.yes,�o-x..,o-rn,+�x..xe...:ew.ees,«.ee..e...e..+•..•.«.ee.e. 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). Da e 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. or Office Use Only Approved application DCI report State certified driving record Website update 1--t 12k�\1 Date k -t �o 71D ..,, a=te co h w ro DerWrA%IDRIVBADGEAPPL92014 mended.DOC 07/2016 '.� W DoT SMARTER 1 51MPLER I CUSTOMER DRIVEN VVWWJovvadot.gov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 180D-532-1121 I Fax: 515-239-1837 www.iowadoLgov Inquiry 3/15/2017 Date: Customer 1533865 Name: Dorr, Scott Edward Certified Abstract of Driving Record DL/ID #: 407AF8706 (IA) CDL Permit Class: None Class: D Audit #: 8940172 Address: 1749 PARK RIDGE DR Issue Date: 03/20/2015 City/State: CORALVILLE, IA 522412741 Mailing 1749 PARK RIDGE DR Address: Mailing CORALVILLE, IA City/State: 522412741 Date of 2/18/1963 Birth: Sex: M Sanctions Expiration 02/18/2020 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: JUR CDL Permit None Restrictions: ID51 ID Status: EXP DL Status: VAL CDL Status: None CDL Permit ELG Status: JUR CDL Cert Status: None CDL Med Status: None Type Effective End ACD Explanation Occurrence JUR JUR Suspended 05/25/2010 08/16/2010 ID51 'Non -Payment of Child Support iIA :IA Suspended {05/25/2011 _ 05/27/2013 D51 Non -Payment of Child tNon-Payment Support 'IA 'IA Suspended 103/26/2014 ;09/14/2014 D51 of Child Support SIA IA Name: Derr, Scott Edward DL/ID: 407AF8706 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 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: 3/15/2017 s IOWA D. O. T, res' ........RJB s' Office of Driver Services Iowa Department of Transportation Name: Dorr, Scott Edward DL/ID: 407AF8706 Apr, I(. LUII� J;4DrIVl Ulv of t,rlminat invest lgaLion ivo,ogly r, I/[ Fr _..._- _._ ____— 06/i2/2017 �a; e.. 92z s/oo2 bilSTATE OF IOWA l Criminal History Reegyd Check Request Form To: '(owa Division of Criminal Investigation Support Operallous Bureau, P Floor 215 r". 7n' Street Des Moines, Iowa 50319 (515) 725-6066 (51S) 725-6080 Fox I alio reauestinc an Iowa Criminal ldismn. Reenrd rhPr.k no - DCI Account Number: _ qoo M-? (ifappliuble) M-om: City of Iowa City _ City Clerk's Office 4101✓. WashinOton Slrcet Iowa City, IA 52240 Phone: 319-356-5041 Fax: 319-356-5497 Last Name mandatory) First Name (mandatory) Middle Name irecmnmended) TJ 0 R -� 5 coir & Uv -P Date of Birth (man//dalory) Gender (mandatory) Social SecurityNumber (recommcndrd) l9 bMale OFemale O O l9 &7 J Waiver rllfor(llalioll: Without a signed waiver from the subject ofthe request, a complete criminal History record may not be releasable, per Code of Iowa, Chapter 692.2. For complete crimina) history record inforination, as allowed bylaw, always obtain a waiver signature from the subject of the re nest. Waiver AeieaSCa hereby give pannlssion for nit a r re teslin In al to ondoet an loNa criminal history record eheekivilh the Division efCrimhtal lnvestigalims(oCO, Any criminal history dma eoncemin M ss unai ed by a DCl may be released as allowed by jaw. Waiver signature: (N I ! Iowa Criminal History Record Check Results (DU Ure only) As of a search of the provided name and dale of birth revrealed: ® No lotus Criminal History Record found with DCI U; .. �` Iowa Criminal History Record attached, DCT # rs DCI initial s DCI -77 (08/25/10) Received Time Apr. 12, 2017 2:36PM No. 8121 MP r. II• [VII J.4Uriy; VIV 01 vflmindl 1nVE5:19dllOn DCI:00456730 NAME: DORR,SCOOTER DORR,SCOTT EDWARD SCOOTER DOB SEX RAC 19630218 M W ADDITIONAL IDENTIFIERS SC L WRIST IOWA CRIMINAL HISTORY DCI 00456730 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2017/04/17 MGT WGT EYE HAIR SKN POE 600 165 BLU SRO MED GA CCH RECORD +'v+ ' 01 ARRESTED/TAKEN INTO CUSTODY 19930328 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA236-2A ASSAULT W/INJURY TRK#+ 005989601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA236-2A SIMPLE ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRH#: 005989601 SENTENCE DISP EFF DAT FINE $50 19930922 02 ARRESTED/TAKEN INTO CUSTODY 19950210 AGENCY: IA0920100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J-2 owl TRK#t 014616901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014616901 SENTENCE DISP EFF DAT JAIL 6D 19950217 PAY SURCHG FINE $500 19950217 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 INo. 0417 r. [/L