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HomeMy WebLinkAbout17-065� r 1 -4 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa S2240-1826 (319) 356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. I -?' G 6 (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: b}Jac k e c u to . x l (, Lov Cell Phone: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 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? 7 Type of offense Where When D u I Cc, r:ily,(Ie 'a(�� -+ What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? C Type of offense Where When What happened to the charge? (Circle one) ; Convicted Dismissed Deferred Suspended Plead Guilty ^-terA 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five y? Type of offense Where e 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 certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number S � O fcA issued on IG 3 expiring on W106Q(b . 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 provisid bif Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) _ - Signature of Applicant Date y -1� 5 - I -f- STATE OF IOWA ) COUNTY OF JOHNSON Sot ribed pnd sworn to before me by ST CCrr �r on this day of +++r+++r++r++++++r+++++r+++»+rr+++r+rr+rr+r+rrr+++r++r++++++rr++++++++++++++++r++rr++rr++r+++rr+++r++rrrrrrrr+r+rrrrrr+++rr+r+rr+++r++r++rr+r+r 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). license I e I i g 1 2 d Y or designee yrLY�1� 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. ���tasil� toe of City Cle k or design a Date �v v o a Office Use Only Approved application DCI report State certified driving record Website update Clerk/TA IDRIVEA Gi WL92014ame d.DOC 07/2016 cu) Clerk/TA IDRIVEA Gi WL92014ame d.DOC 07/2016 CIowa Department of Transportation AO CMfice or Unew Services lTal Free) 800-532.1121 PO Bol 9201, nes Manes, 1A 503069204 515-244-9124 FAX 515.2391837 Certified Abstract of Driving Record Inquiry Date: 4/19/2017 DL/ID #: 555xx5019 (IA) Customer #: 3919725 Name: Erb, Stuart John Class: D ID Status: EXP Address: 1301 OAKCREST ST Audit #: 7394299 DL Status: VAL Issue Date: 10/01/2013 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 10/08/2018 CDL Cert Status: None 522461619 Endorsements: 3 CDL Med Status: None Mailing Address: 1301 OAKCREST ST Restrictions: NONE Restriction None Supplement: Date of Birth: 10/8/1986 Mailing IOWA CITY, IA Sex: M City/State: 522461619 History Information Convictions Citation Date Conviction Date ACD Explanation Coun JUR 12/17/2006 04/09/2007 A20 Deferred Judgment Johnson OWI IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation JUR 1countv 112/17/2006 A98 OWI Test Failure IA Sanctions Type Effective End ACD Explanation Occurrence 7UR JUR Revoked 112,/28/2006 06 25 2007 A98 I OWI Test Failure IA IA Name: Erb, Stuart John DL/ID: 555xx5019 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: IOWA '*-:rP' D. 0. T. Name: Erb, Stuart John DL/ID: SSSmSO19 4/19/2017 Office of Driver Services Iowa Department of Transporation 04/APrj 1. 2017111.49AM Cab Div of_C_riminaI Investigation STATE OF IOWA Criminal History Record Check Request Form (FAX)31933$2:N0' 6838 P'„02/002 DCl Account Number; 9967-F �— (Irspidcab ly) To: Iawa.DIVlslon of Criminal Investigation Frame Yellow Cab of Iowa City Support operations Bureau, V Floor P.O. Box 428 215 E, 7'a Street Des Moines, Iowa 50319 Iowa City, LA. 62244 (515)725.6066 (616)726.6080 Fax (319) 339.9777 'Phone; � Fax, (319)339-7302 l am requesitna an Iowa Criminal Hlsto Record Check on: Last Name mandatory) drat Name mandato' Middle Name (recommended Date of Birth (mendolo Gender nordwo Social Security Number 1 0- O a` l� s 6 VNxale ©Female ^rerummondod) q 4� — I) _q pit{ o Waiverlr(/brmattort: Without a signed waiver from the subject of the requeiy a enmplele orlminal history record may not bo releasable, PerCodo of Iowa, Chapter 692.2, For. eta criminal history record Information, as allowed bylaw, always obtain a waiver sl Nature from the subject of the request. Waiver Relgass t hereby give penplasloo rer the Wove requesting oalelal la conduct w Iowa orlminol Wno ytaaM vhcck wlih that Division orcrlminal Inveldgadon(DCI):.Any criminal history data whoom. shot is ms(nlained by the DCl may be�nlewed u silowed by low. Wlriver Signature, 1 Iowa Criminal History R,eggrd Check Results Pei uss only) 1 AS of � i It search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCL Al - DCI initials D DCI -77 (08/25/10) Received Time Apr. 19, 2017 2:25PM No, 7509 Apr.21. 2017 11:49AM Div of Criminal Investigation DCI:00792126 NAME: ERB,STUART JOHN DOB SEX RAC 19861008 M W IOWA CRIMINAL HISTORY DCI 00792126 NON CONVICTION PAGE 1 OF 2 DATE PRINTED - 2017/04/21 NGT WGT EYE HAIR SKN POB 600 230 BLU BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE% Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 2OD61217 AGENCY: IA052DI00 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 1ST OFF TRK#: IAOOOGZ01 CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: IAOOOGZ02 COURT DIUP06XTION AGENCY% IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VRH WH INT (OWI) / IST OPP COURT CASE ID; 06521 OWCA078161 CHARGE CLASS: NON CONVICTION TRK#: 1A000GS01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY UNSUPERVISED UNDER DOC COMMUNITY SERVICE 50H DISCHARGED FROM DEFERRED JUDGEMENT COURT DISPOSITION AGENCY% IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 OWCH070161 CHARGE CLASS: NON CONVICTION TRK#: 1A000GZ02 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY UNSUPERVISED UNDER DOC COMMUNITY SERVICE 50H DISCHARGED FROM DEFERRED JUDGEMENT No.8838 P. 2 DISP EFF DAT APPEAL DATE 20070409 20070409 20071101 20070409 20071109 DISP EFF DAT APPEAL DATE 20070409 20070409 20071101 20070409 20071109 Apr.21. 2017 11:49AM Div of Criminal Investigation No.8838 P. 3 DCI 00792126 PAGE 2 OF 2 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 PURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBCECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION