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HomeMy WebLinkAbout17-0864; CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319)356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. D (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 First 3. Contact Information (REQUIRED) Email: (All written 4a. Driver's License expiration date (REQUIRED) _ b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: Middle 1 Last 11A V7 (�.c l r CII Phone: munication sent via mail) ,� 7 O ,/� baa CL4-,G 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense _ Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended 'Plead Gui� Other 7. Have you been arrested / charged with any traffic offenses in the last five years? (L.c 91 Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ Type of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please �r GIt) --- DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE When U You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 1 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby c rtif that I have issued to me by the Iowa Department of Transportation a valid Driver's license number t Z issued on 54(lkl ! I expiring on / 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 AA of Title 5, Chap r 2, of th City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant W �L Date s-1 _?� ii##nn444Y4441n1111n1f*#n*+++#++#####n###4#Y444n44fifn41f4##1f+4++S+1r#++######Y####4n1nf4f **111#44**14444*1*1*#+##H########4#44##4#4Y STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by -er , ! r on this ZD day of e— 1 i VYENDY S_MAYER _j Y4otary Public ' nd for the State of 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 gAy_of_Iowa GitMitle 5, Chapter 2, City Code). /license a'�zal l� designee I Dat 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. re o ity C er c or eslgnee Office Use Only Approved application DCI report State certified driving record Website update � Date C-) ={C-) o r .rn -0 ^m T CleM1drA%IDRI MDGEAPPL92014am nded.DOC 07/2016 Iowa Department of Transportation AC e of Drwu Semam (I oil F" $ 532.1121 PO Ow 932[64, Des M01111811, V 503(15 9204 515-244-9124 PAX -'515-239-1831 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 6/8/2017 DL/ID #: 841ZZ8616(IA) Customer #: 2808014 Name: Barber, Keri Class: C ID Status: EXP No Driver's License Kathleen IA Address: 2718 WAYNE AVE Audit #: 1821082 OL Status: VAL APT 8 Issue Date: 05/18/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 09/15/2022 CDL Cert Status: None 522402533 Endorsements: NONE CDL Med Status: None Mailing Address: 2718 WAYNE AVE Restrictions: Corrective Lenses Restriction None APT 8 Supplement: Date of Birth: 9/15/1969 Mailing IOWA CITY, IA sex: F City/State: 522402533 History Information Convictions Citation Date Conviction Date ACD Explanation County ]UR 07/19/2005 10/20/2005 A20 Operating While Intoxicated Johnson IA 04 12/2008 05/06/2008 B51 No Driver's License Linn IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation ]UR County 07 19 2005 Al2 OWI Test Refusal ]A 107/29/2007 Sanctions Type Effective End ACD Explanation Occurrence ]UR ]UR Revoked 107/30 2005 107/29/2007 JA12 I OWI Test Refusal I IA IA N O C, t. Name: Barber, Keri Kathleen DL/ID: 841ZZ8616 C7 I --i C') Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departmel4FhTranoortati6ri! So S hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is attu' d agate Juf an official record currently in the custody of said Office, and that I have been authorized by the Director the IoW'* 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 D. 0. T. Name: Barber, Keri Kathleen DL/ID: 841ZZ8616 6/8/2017 Office of Driver Services Iowa Department of Transporation N O_ l7 J L o r =.'K N Ju n. 15. 2017 5:02 PM Div of Criminal Investigation o6/ucreuli rs:Sr yellow Cab or Iowa city STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Invesilgailon Support Operations Bureau, I" Floor 215 R. >1e Street Dae Mateee, Iowa 50319 (516)725.6066 I am ranuewino an (nava Criminal Wlarnm n•nnrd e'hnntr nn. No. 3148 P. 3/7 (FAX)31933827ud P. UU2/002 DCI Account Number: _9967-F (irappllcable) Frotnt ')yellow Cab of Iowa City _ P.O. Box 428 Iowa City, IA.. 52244 Phone: � ------ ---- Fax: ...Fax: (319)339.7302 Last Name (menduo First Name mandalo recemmanded ' Middle Namep bar lam `N Daa�te of Birth (mandarory) Gender (mandatory) Social SecurityNummbi; imcommended) "/ l 1 J I � / ❑Male i)dFemale t� ,omGZ -S`5 Waiverbtformaflon. Without m signed walver from the subject of the request, a domplete Criminal history record may not be releasable,'per Code of Iowa, Chapter 692.2. For oomolcto oriminal blstory record Information, as allowed bylaw, always obtain a waiver signature from the subject or the request. Waiver Ralease:I hrreky glvc penntrslon air the above ropueninp oficlsl to conduct on lows cdmfnal hlaory record Checktvllh die Dlvldon orCominal Inveedgarlon(W). Any orlminal blewry demecneeminam� malolaiptdby tho DCl ybe lowed by law. Waiver signature; As of �e� �� a search of the provided name and date of birth revealed: © No Iowa Criminal History Record found with DCT Iowa Criminai History Record attached, DCl DCT initialsYJ6Q DCI -77 (08/25/10) Received Time Jun, R. 9011 9:09PM No.1080 (PCI uw only) F.a `N n rn ilC7 —3 7.N Jun.15. 2017 5:02PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00395847 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2017/06/15 DCI:00395847 NAME: BARBER,KERI KATHLEEN DOB SEX RAC HGT WGT EYE HAIR SKN POB 19690915 F W 505 185 SRO ELK MSR IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC L ANKL TAT R ANKL DISP EFF DAT 19900130 19900130 19901210 DISP EFF DAT 19900405 No. 3148 P. 4/7 N Q O -�S� CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19891001 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI M TRK#: L36882501 COURT DISPOSITION i+ AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VER WH INT OWI CHARGE CLASS: NON CONVICTION TRK#: L36882501 SENTENCE DEFERRED JUDGEMENT PROBATION 1Y DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRSSTSD/TAKEN INTO CUSTODY 19900114 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE TA321J-21 DRIVING WHILE REVOKED TRK#: L36002601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 TA STATUTE: IA321J-21 DRIVS WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L36882601 SENTENCE JAIL 2D 03 ARRESTED/TAXSN INTO CUSTODY 19960810 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-1 THEFT 4TH TRK#: 019242801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-1 THSFT 4TH DISP EFF DAT 19900130 19900130 19901210 DISP EFF DAT 19900405 No. 3148 P. 4/7 N Q O -�S� —a L • f 7 � --Ah N a r r M i+ .J J Jun.15. 2017 5:02PM Div of Criminal Investigation No.3148 P. 5/7 DCI 00395847 PAGE 2 OF 4 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 019242801 SENTENCE DI$P EFF DAT JAIL 14D 19951015 FINE $250 19970124 PROBATION lY 19970124 SUSPENDED 30D 19970124 REVOKED 19981015 04 ARRESTED/TAKEN INTO CUSTODY 19980606 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA321J-2(28) OWI 2ND OFFENSE TRK#: 040825601 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J,2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 040825601 SENTENCE DISP EFF DAT PLEAD GUILTY 19981026 JAIL 20D 19961026 FINE $1000 19981026 SUSPENDED FINE $500 19981026 COURT COSTS 19981026 05 ARRESTED/TAKEN INTO CUSTODY 20050719 AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE 1A321J.2 0wT 2ND N a TRK#: 101595501 CD CHARGE NO- 02 IA STATUTE IA726.6 CHILD ENDANGERMENT TRK#: 101595502 O COURT DISPOSITION AGENCY- IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFS COURT CASE ID: 06521 OWCRO73154 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101595501 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 7D 20051020 FINE $1500 20051020 Ju n. 15, 2017 5 : 0 2 P M Div of Criminal Investigation Na 3 14 8 P. 6/7 DCT 00395847 PAGE 3 OP 4 COURT DISPOSITION AGENCY: IA0520151T JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE; IA726.6(7) ENDANGERMENT/NO INJURY COURT CASE ID: 06521 OWCRO73154 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#- 101595502 SENTENCE DISP EFF DAT JAIL 7D 20051020 FINE $500 20051020 06 ARRESTED/TAKEN INTO CUSTODY 20051120 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA321J.21 DRIVING WHILE REVOKED TRK#: 503334401 COURT DISPOSITION AGENCY: IA057015.7 LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA321A.32 OPERATING VEH/W LICENSE SUSPENDED (FINANCIAL) - 1978 COURT CASE ID: 06571 SRCRO64399 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 503334401 SENTENCE DISP EFF DAT TIME SERVED 20060111 FINE $250 20060111 JAIL 2D 20060217 07 ARRBSTED/TAKEN INTO CUSTODY 20120103 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG TRK#• SAOOFME01 •� COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 02 IA STATUTE: IA123.46 -i C7 CD (� CT CONSUMPTION / INTOXICATION - 1970 COURT CASE ID: 06571 SRCRO96896 N Q CHARGE CLASS: MISDEMEANOR CONVICTION r' t3 TRK#: 5AOOFME02 --� SENTENCE DISP EFF DAT FINE $65 20120530 08 ARRESTED/TAKEN INTO CUSTODY 20120411 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA725.1 PROSTITUTION - 1978 TRK#• 5A00GII01 COURT DISPOSITION Jun.15. 2017 5:03PM Div of Criminal Investigation DCT 00395847 PAGE 4 OF 4 AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA725.1 PROSTITUTION - 1978 COURT CASE ID: 06571 AGCR098220 CHARM CLASS: MISDEMEANOR CONVICTION TRK#: 5A00GII01 SENTENCE DIBP EFF DAT FINE $625 20120530 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 No. 3148 P. 7/7 C7 ^r �-\ CD O C-) Z� NJ, }> f 4 J