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Home My WebLink About17-082J r 1 _ I CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 3S6-5040 (319)356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. / -1 — OV Z. (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 Middle Last 2. Address (REQUIRED) 6 5 ( f Vv -1 dine. 54, Jf L So C.1�., tq 3722--( 6 3. Contact Information (REQUIRED) Email: A oik a hr,r„ r / 1 q 615 r4, Cell Phone: (All written communicatio sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) /yj,A 5. Prior experience in transportation of passengers: 03/ UV 262-1 0,5 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State Type of offense Where N O_ J P, elsewpere? -4* L When What happened to the ch cle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where WhenI op J �(ti za3 l tip:rr rA%44 c n =a k ab I Zn What happened to the charge? ( cle one) Convicted ismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ye 5 Type of offense Where When ��d1� /obl� Co�� i �9 y/�1, 6_I�ZRm CD 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please p tl Wname� /✓r, —, — r DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE D ,W, You must apply for an individual Department of Criminal Investigation Report (form available uporr request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 F.- % APPI.ICATION FOR TAXICAB VEHICLE DRIVER • Page 2 I hereby cert' that I have issued to me by the Iowa Department of Transportation a valid Driver's license number �i 3 iZ fs765 issued on VL lZolbexpiring on -3 /30/ZO23. 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 f HHHtlYIIHIfIHHIHTTIHITRTFlIHIfllYYHYHIHHY!#YYYYYIf llflfYf f iflf 11H1fYlHY+YY11f f f1f f YYlY11HH1fyYYly!!!}!!#YYHti'ifll!!fH!ltlYiH STATE OF IOWA ) COUNTY OF JOHNSON ) and Wrn jp before me by on this 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 �33�23 Signature o P lice hidesignee 953117 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. Si of City C erk or designee Office Use Only Approved application DCI report State certified driving record Website update 1131 ) Date N O J C-)-< w r �� rn o rx 'i7 t CIWTAXIDRN DGEAPPL92014amendw DOC 07%2016 TA Pagel of 2 °Jk �ADOT SMARTERwwwAloWBdot gov i SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 i Des Moines, IA 50306-9204 Phone: 515-244-9124 1 800.532-1121 I Fax: 515-239-1837 Ww Jowadot.gov History Information Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 04/11/2016 04/20/2016 D51 Non -Payment of Child Support IA IA Name: Thomas, Andrew Aaron DL/ID: 433ZZ8765 Pursuant to Iowa Code §321.10, 1, 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. N In witness whereof, I have caused my signature and the seal of the Department to be set upon tbia docurtt, at Ankeny, Iowa this date: p MC m�4 rn ®~r; • �' 4y 5/31/2017 Fn 3 a: IOWA 4 JC' � O '7 r v 4r �IYLd � Office of Driver Services .� Iowa Department of Transportation 5/31/2017 Certified Abstract of Driving Record Inquiry 5/31/2017 DL/ID #: 433ZZ8765(IA) CDL Permit Class: None Date: Customer 2169524 Class: D CDL Permit Issue None #: Date: Name: Thomas, Andrew Aaron Audit #: 9955565 CDL Permit None Expiration Date: Address: 631 S VAN BUREN ST Issue Date: 04/22/2016 CDL Permit None APT 2 Endorsements: Expiration 03/30/2023 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: None 522404807 Mailing 631 S VAN BUREN ST Restrictions: NONE DL Status: VAL Address: APT 2 Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522404807 Status: Date of 3/30/1987 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 04/11/2016 04/20/2016 D51 Non -Payment of Child Support IA IA Name: Thomas, Andrew Aaron DL/ID: 433ZZ8765 Pursuant to Iowa Code §321.10, 1, 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. N In witness whereof, I have caused my signature and the seal of the Department to be set upon tbia docurtt, at Ankeny, Iowa this date: p MC m�4 rn ®~r; • �' 4y 5/31/2017 Fn 3 a: IOWA 4 JC' � O '7 r v 4r �IYLd � Office of Driver Services .� Iowa Department of Transportation 5/31/2017 ,,,May. J.U. LUII,,. Z:J9- M7eikUiv of 0iminal Investigation 06122/2017 oe:CNo' unIto, Y. V9r002 STATE OF IOWA 01.1 c(_:r2rrcHl�at l�istol� taecorfd t:EiecC� + Request IForni ;s DCI Account Namber. �QQZ= (if applicable) To: lurva Division of Criminal Invesligatiou From; City of Cewa Cicy__ Support Operations Bureau, 1s' Floor City Clerh'.s Office 215 I:, 7'a Street _4.10 L. Washington Stract Des Noiues, Iowa S0319 (515) 725.6080 FBI Phone: 319-356-5041 Fax: 319-356.5497 I am renuestinm an IOWA Criminal 14ictnry Rernrd Cherk nit - Last mandaio ,) First Name (mandatory) Middle Name (recommended) (Name Tholm'o 5 4n'/rzf't/ f4-�oH Date of Birtthh/ bnanduop9 Gendderr((mandatory) Social Secuii Number Uecomm� mded) a ale ®Female I�0/ Waiver Inforniafionr Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of lows, Chapter 692.2. For complete criminal history record information, as alloy -ed by law, always obtain a waiver si nature from the subject of the request. Waiver lie/ease: l hortbysivc pcnnlssion for the above requesting official to cenduq an Iowa criminal history record check ,rim the Division ofCr6ototl htvesligalion (DCI). Any criminal history data easeming�nitdial is nsiolafno CI maybe aleased as allowed bylaw. \\ WaiverSionnfure: / W MA Iowa Criminal History Record Check Results (Dcl use only) As of g�o?' BO' (,_, a search of the provided name and dale of birth revented: a No Iowa Winjnal History Record found with DCI Cell Iowa Criminal History Record attached, DO DCl hiitials_ DCI -77 (08/25/10) Received Time May,22. 2017 8:43AM No.9737