HomeMy WebLinkAbout17-09940 IDENTIFICATION NO. I 0 9`�
l 1 (Office Use Only)
III
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 Streel
Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application
(319)356-SO40
(319)356-5497 FAX
First Mid_ dle_ Last
1. Name(REQUIRED) �i4hnLS M t�(cC CALLOW
2. Address (REQUIRED) 3036 ril? sl,i�' S�. IDtcd c,�, TA S'.2245
3. Contact Information (REQUIRED) Email: JiwCaga �r�Qb��wwil, C0� Cell Phone: 3lcf- 936 Pq6
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) t /2a /oto,2 4
b. Taxicab Business Name (REQUIRED) IkkACCO S TaXt
5. Prior experience in transportation of passengers: r �f5 �Ylvtk�( Cc.
N
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this Statgrelsem+B�iere?: OO
I
_Type of offense Where
M m
a S N
What happened to the charge? (Circle one) ,w
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested/ charged with any traffic offenses in the last five years? NO
Type of offense Where When
What happened to the charge? (Circle one)
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? NV
Tvoe of offense Where When
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 certi that I have issued to me by the Iowa Department of Transportation valid Driver's license number
3Va 8 a�SB issued on01i ;Wh'- expiring on oi,110aa9-'f . 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 Applicant Date 06/,001F
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by W ct S4 on this 4 day of
vgvs� �ol�
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Nota in and for the State f Iowa
111111111,/,i,1111*##1A`1*#1,Y111#1111111111111111111lf11111*#1#*111#11fHe1tMf14f1h1111111#1#1**##11111#'R#1111#111#f#11#11#1#'1Mk`etM4lN#1111111,111111
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 —1-11I 7o1j.2y
designee
Fn a
I bate
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.
ig ature of City Clerk P esignee Date
xxxxsrxxxxxxxxxxxxxxxxtxxxxxxxxtxxfftxflxfttxflxlfxflxxlxlf!!LfllllHflHf!!f!f#i##+#f:FRf!!#R!#RlflHflllHf'M� �#lfi=^ f!f!!f!M!
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Office Use Only K r
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Approved application O3 �9 M
DCI report ry Q
State certified driving record cls
Website update ko
Clery A%IDRNBADGEAPPL92014amnded.DOC 07/2016
081 Aug. 4. 2017 1N
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Div of Criminal Investigation � DCl l00o.4210
An 1
STATE OF IOWA' t�
Criminal History Record Check
Request Form
DCI Account Number.-FC-
(doptdlallo) ,
To, laws DlvielonofComWdYoveetigodor From: �aYY�5�ax1
SvpportOperadom13areAa,1"Moor 4 5+tvtNs Ort
215 E. 7m Street
Deg MOInes.TOWS 50319 wile
F.: Il 31q) 370'
Phone:
Far; 3['151
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iam EgAgLh
Lot Name i„D,d, W) a nmmai rusty
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Mddle Name row
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Date of Birch
Gender
swiial�§M0 NDm'b/er mm
011AD 11676-`6
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Waiver leormadon. Without R alwed waiver from the Ambled of the regaeat, A eempleto criminal hbtory record woy met
be relearabU4 par Code of Iowa, Chapter 692.2, For colliplo orimleal history record information, It allowed by law, Always
obtain a wAlvar 61990turf ham the Ambled of the r mast.
Waiver Rejdg8e11 hoaoey Pvt p,r,olNlno far dro&Wye mq�ft oraoi.l iv o nbdeelam okaod history wow cheek whh tre Divillon arL7imiml
lmadAD;on (M). Aw mbdw blaay den ee y me lhet m auinuOwdM the DGt msy he released A: ptaxnA hY law-
._ -- — — - ----- -
.
Waiver SIQltallw'8: ��
(DCI wa only)
As of !k-- L ' ��, a Search of the provided name and date ofbifth revealed;
No Iowa Criminal History Record found with DCI
[3 Iowa Criminal history Record attached, DCI #
DCI initials 1 1
Received Time Aug. 1. 2017 9:38AM No -3848
ARTS Page 1 of 2
�
C1J1U'0`WAD0T
SIMPLER I CUSTOMER DRIVEN www,lowadot.gov
SMARTER 15
I M
Office of Driver Services
PO Box 9204 1 Des Moines. IA 50306-9204
Phone: 515-244-9124 ) B00-532-1121 1 Fax: 515-239-1837
wwwJmvadot.gov
Certified Abstract of Driving Record
Inquiry
8/4/2017
DL/ID #:
302BB2858(IA)
Date:
None
Endorsements:
Customer
1808601
Class:
B
ID Status:
None
DL Status:
VAL
Name:
Calloway, James Michael
Audit #:
9780064
Address:
3036 FRIENDSHIP ST
Issue Date:
02/13/2016
Expiration
01/20/2024
Date:
City/State:
IOWA CITY, IA
Endorsements: NONE
522455112
Mailing
3036 FRIENDSHIP ST
Restrictions:
CDL Intrastate Only
Address:
Restriction
None
Mailing
IOWA CITY, IA
Supplement:
City/State:
522455112
Date of
1/20/1968
Birth:
Sex:
M
CDL Downgrades
CDL Permit Class: None
CDL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
CDL Permit
None
Endorsements:
CDL Permit
None
Restrictions:
ID Status:
None
DL Status:
VAL
CDL Status:
VAL
CDL Permit
ELG
Status:
CDL Cert Status:
Excepted Intrastate
CDL Med Status: None
Effective _ End Issuing JUR
04/30/2014 _ — 02/12/2016 - -- IIA —__ ---___--
History Information
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date JUR Case Number
08/08/2013 IA 754691
09/18/2015 IA 1879129
Name: Calloway, James Michael DL/ID: 302BB2858 (IA)
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:
http://172.29.254.55/drivers/reports/eustomerhistorylcertifieddrivingrecord.aspx 8/4/2017
ARTS
8/4/2017
Office of Driver Services
Iowa Department of Transportation
Name: Calloway, James Michael DL/ID: 302BB2858 (IA)
Page 2 of 2
http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/4/2017