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HomeMy WebLinkAbout17-085CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. (Office Gie 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 o CF. Sowo, C:+,,, TA saayD 3. Contact Information REQUIRED Email: Q(-�CY�P)50t'\(oSl "? shoo, y (REQUIRED) Y well Phone: (All written communications nt via email) 4a. Driver's License expiration date (REQUIRED) 6116/1-7 b. Taxicab Business Name (REQUIRED) and fco", T&A 1 5. Prior experience in transportation of passengers: 4ov'F" I Ei leATrj N _s 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this Type of offense Where a, C% n-<ewA@re�_� cn What happened to the charge? (Circle one) Convicte Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? / o Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other .. II 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1Vo Type 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) NC) 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 1 1 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I heree+b�yye i t�ha��lve issued to me by the Iowa D part ent of Tran rt n a valid Driver's license number issued on 17 0 expiring onG/1(011 i 1 understand that K 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 /ftp r' \ Date STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by S s � Gy , N ) Q �5cw� on this / to day 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 City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license 06 • o S• z62-9, Signature ofPolice Chief or designee 040 •/G •2o f 7 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. Sig of City Jerk or designee H1f*1flHH#HMH4H#HfHH****}*#-#####f#i}4HHfHfIHf HRH*##4##i4HffH1H1f!*fHff**Hk***#44H4HHHffHHHlf�frY#11#YffH11H41H1f Q Office Use Only h -e v _ 2 hK Approved application ~n r om DCI report O TA r , 1 State certified driving record _1E -R Website update 0 GeWTAXIDRWBADGE. L92014a.ded.DOC 07/2016 k,ZiUh&'AD0T SMARTER 151MPLER I CUSTOMER DRIVEN WWW,IpWadot.gov Inquiry 5/17/2017 Date: Customer 2301096 Name: Nelson, Eric Vernon Address: 1912 HANNAH 30 CT City/State: IOWA CITY, IA 522403080 Mailing 1912 HANNAH 30 CT Address: Mailing IOWA CITY, IA City/State: 522403080 Date of 6/5/1976 Birth: Sex: M Yage 1 of l Office of Driver Services PO Box 9204 I Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 www.iowadct.gov Certified Abstract of Driving Record DL/ID #: 464KK6798 (IA) CDL Permit Class: None Class: D CDL Permit Issue None ' Iowa Department of Transportation Date: Audit #: 6011555 CDL Permit None Expiration Date: Issue Date: 05/29/2012 CDL Permit None Endorsements: Expiration 06/05/2017 CDL Permit None Date: Restrictions: Endorsements:3 ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELO Status: CDL Cert Status: None CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Nelson, Eric Vernon DL/ID: 464KK6798 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: •%;T/�6i 5/17/2017 fOfl�S' Da Office of Driver Services ' Iowa Department of Transportation Name: Nelson, Eric Vernon DL/ID: 464KK6798 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 5/17/2017 I 05111Ra y. IV. LV I.1 ]_4L r IYI 1. VIV or urlminal Investigation ., DCI IowNo-9434 P. 2/4 WJ U M STATE OF IUWA Criminal History Record Check Request Form To: laws Dlvblon ofCominw mvedlp idea 7 � 7 e pp�tloue Pureap, 131eor 11 We Motnw, rows 30319 (515)733.6066 (3Is) 713.6010 Fax I am reauesdnk an Iowa Criminnl liltm;v RO: rd rh, & .: DCI Account Number: '{313 - FC- From: _ Malrfag 'FjL)(1 116 ,54vev-S ©1', phone: -'( 314 338- F:lx:. • 319) 551 a LaatMiame g=n&ftm First N me 1 MlddleNome"Luper iJ06 ►(\ ErA'c. \Jernan Date of_BirW (lender :wwlo Social &curl Number (0/57/-76 j Male OFcmale L 1c) � I 9-�(Oco rr("FVrargorrM"Wn: w:Rootaelpodwalvortromthe subjectoftherogtj acompletecriminalbtetoryrccarAmayMae be reMnaWe, per Code of Iowa, Chapter 693,1. For cog(uJ� erlmlaal Wary erootd Ipfo:mRnon, u allowed re ord may 00 ebtaln ■ WAIVAT alonalnrh aw.. ON. ...hg..w.rw1........_.• WdiverRelease:lhat'rirepmiusonfords■bavefelW14W kW toemmldmton u1mhWhhm:yenxlticheekwdu,theDIWe7enofCrhJae1 ("Vooptlon(oCh. Any etl®amll""yden Ow"n" 9M"19 nuW dby ftDct tlny bee bkW u alowod by taw. Waiver SJgnatiod; —_ - _— •... ..Q�_;�n�wwr vuvt. A\iANa (DCLmwM As of a search of the provided name and date of b1A rovonw: 13 No Iowa Criminal HfSWry Record foundwith DCI Lip Town Cr)miW History Record a(tachod, DCI fi • M1So Del Initials_ �y L Received Time May. 11. 2017 1:08PM No.0398 1 ninny. iu• CV II ]:`tzrivi u 1 v 0 1,,riminaI Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00518350 NAME: NELSON,ERIC VERNON DOB SEX RAC HGT WGT 19760605 M W 602 250 DCI 00518350 PAGE 1 OF 2 DATE PRINTED - 2017/05/16 EYE HAIR SKN POB BLU BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19960229 AGENCY: IA0520400 IOWA CITY UN1V SEC PD CHARGE NO- 02 IA STATUTE IA124-401-3 POSSBESION/SCHF.DULR I/MUSHROOMS TRK#: 018655002 CHARGE NO- 03 IA STATUTE IA124-401-1D POSSE9SIO14W/INTENT DELIVER MARIJUANA TRK#: 018655803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSSESSION/COtd'1TROLLED SUBSTANCE SCHEUDLE I/ MUSHROOMS COURT CASE ID: PECR40720 TRK#: 016655801 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960628 COURT COSTS 19960628 PROBATION 2Y 19960628 COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA124-401(1)(D; POSSRSSION/ W/INTENT TO DELIVER/ MARIJUANA COURT CASE ID: FECRO40720 TRK#: 016655802 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960628 COURT COSTS 19960628 PROBATION 2Y 19960628 02 ARRESTED/TAKEN INTO CUSTODY 20070422 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TRK#: IAOOIAO02 COURT DISPOSITION AGENCY: IA052015LY JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 FECR079287 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IADOIA003 No. 9434 P. 3/4 WidY, iu. [u ii 7:Lt[rni viv U �,riIII 10dI InvC5L]9dLi0n V0.74J4 Y. 4/4 SENTENCE JAIL DCI 00518350 PAGE 2 OF 2 DISP EFF DAT 21) 20070919 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 RRLEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE OCT, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDRNTIFICATION 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 I