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Home My WebLink About17-102 IDENTIFICATION NO. /---/ r /OZ-- J , ' I — 1 (Office Use Only) ��.w;P:l APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday) 410 Cast Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX Fist iddl� AA La t 1. Name (REQUIRED) 7&brims I -� }ibrm o.w+ /"I,ck_o.v I„ 2. Address (REQUIRED) 2 11 5 3- S-1. Ap#. 2 1 Tot,ic. C, , • A, 5ZZ'd I y319-s�2-583 3. Contact Information (REQUIRED) Email: SCAf'pi o�o��q►^1q , I. fi''''t ) Cell Phone: (All written o mu ation sent via email 4a. Driver's License expiration date (REQUIRED)/ —_j /52/Zd I g b. Taxicab Business Name (REQUIRED) lelloW�/ /C./ j (4 . 11 o wa. Cir: y —�- 5. Prior experience in transportation of passengers: /Cil Go L.l LP- b i,d ickrc0`5 /E.x1 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere?/Or Type of offense WhereWhen 1.....J0%._ \,:,_/ -17 y C/ 0 0 g. What happened to the charge? (Circle one) Convicted Dismissed 6efe7re Suspended Plead Guilty Other 7. Have you been arrested/charged with any traffic offenses in the last five years? y e S Type of offense Where When s�e'Jl 1) P\USca4;ve, -14 3/ //6 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? Type of offense n'_ Where When SVS?4.wcl2.Cl - A)Oh Pa r,.•,///' CI�,Id 5 urr1 uc IO wo ' Jit/16. 2 9. Have ou ever applied to be an Iowa City taxi driver using a different name? If yes, pleaseps4de f na c co r DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT ERTIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE' 1EF HEVIE� C) You must apply for an individual Department of Criminal Investigation Report(form available ettibn request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 r J , APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereb cgrtjfy,that I have issued to me by the Iowa D artment of Transportati a v lid Driver's license number (o `� rr 11F50 F50 issued on /i 6/(G expiring on 62 Oil. I understand that if I falsely answer any questions in this application, that this ap ication may be denied. gre that in making this application, 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 U/4 l 7 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Go) (; g A . Ike, 0)—.— k on this 6 day of u&31- X1-1 . Q �•a WENOY S YE 9428 No ary Public ants•r the State of Iowa ' / 1r•Nitri • WIN 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 •• •f Iowa City(Title 5, Chapter 2, City Code). Expire'on da - • Drive s license 1( (L' I I /Dat(" ? Signture k fP 7 or designee 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. l ._._- 14.-4 e:e I) ,-er O g ig ature of City Clerk of-designee () Date Office Use Only •v Approved application t74::::,4::::, DCI report * c s State certified driving record a Website update l?-t 1 --f CI CO r W i r Gerk/TAXIDRNBADGEAPPL92014amended.DOC C 07/2016 Ll1ir iu: �:+r+m uiv of t;riminal investigation No. 3421 P. 1/2 Q7/�vtuii ata; i9,c+i ,vs� Cab Ui iura i �p (FAX}319336271, .,,u�,p02 • • � f STATE OF IOWA 44.- �;,,,. .. h M1 . j'-', ;N��[Tild11\,\�: ' Criminal History Record Check t,;. r: :e ;��gf .:�v Request Form Yr G ,! r-.t (til DCI Acoount Number; 9967-F ((repelicabic) To: Town Division of Criminal lnveatlgetfotJ' Support Operations Bureau, 1"Floor From: Yellow Cabof Iowa Clry • 215 Z. 7" Street P.O. Box 4 428 Des Moines, lows 50319 (515)725-6066 Iowa C[ty, iA. 52244 — (515y72s 60.8{1 Fax (319)338-9'/I'/ Phone: Fe ' (319)339-7302 I am rc.uostin: an Iowa Criminal Histo Record Check on; Last Name (mandatory) First Name(mandatory) • _ ' ?YXtddle Name(reeommcnded) ill;CICLU- 4 C•.bPl ell ' > S1M Dater() Birth mandato ' • .----- ' GendeI I 2/ r modelle - = • 'Social•�I S� 9/�/acurlNumbesr�(reoommendea> Male °Female 3o p/ — /"! 2(. F 7 47r-river Information: Without a signed waiver from the subject of the request,a complete Om inn)history record may not bo releasable,per Code of Iowa,Chapter 692.2.icor eQrrlgiotg criminal history•reeor0 Information, as allowed by law,always obtain a waiver si_nature from the sub ect of the re.cost. - Waiver.Release:I hardly give permission for the above requesting official to conduct in lows criminal history record check whit the Division of Criminal 'investigation(DCI). Any criminal history data coneeminj me that is maintained b the DCI may be released as allowed by law. Waiver Signatur ��'/1.. . ' Iowa Criminal History Record Check Results (DCI use only) As of '----/ -c -- r-1 , a search of the provided name and date of birth revealed; EA No Iowa Criminal History Record found with DCI P c 3 , {� � a Iowa Criminal History Record attnohed, DCI 0.2 c� �• Ie.._ CoDCI initials- .{ -ra rn • DC1-77 (08/25/10)• ,-.y c:3 co Received Time Jul. 21. 2017 8:29AM No. 3273 Jul. 25. 2017 10: 54AM Div of Criminal Investigation No. 3421 P. 2/2 IOWA CRIMINAL HISTORY NON CONVICTION DCI 00828848 PAGE PRINTED-1 EF DATE DCI:00828848 2017/07/25 NAME; MIDDAUGH,QABRIBL ABRAHAM • • DOB SEX RAC HGT WGT EYE HAIR SKN POB 19841102 M B 508 145 BRO BLK LBR MI ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L SHLD TAT LF ARM TAT NECK TAT R SHLD TAT RP ARM CCN RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20080306 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J.2 (A) OPER VEH WH INT (OWI) / 1ST OFF TRK#: 1A003K001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J 2 (A) OPER VBH NH INT (OWI) / 1ST OFF COURT CASE ID; 06521 OWCR082561 CHARGE CLASS: NON CONVICTION TRK#: 1A003K001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $625 CIVIL PENALTY 20080521 PROBATION 1Y 20080521 UNSUPERVISED TO DCS DISCHARGED FROM 20090213 DEFERRED JUDGEMENT 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 VrC: 1111 C)--4 I f..,. < : 3E3110 rn w Ut Iowa Department of Transportation 4,4111pNotice of Driver Services (roll Free)80-532-1121 PO Box 9204,Des Moines,lA 50306-9204 515-244-9124 FAX:515.2391837 Certified Abstract of Driving Record Inquiry Date: 8/7/2017 DL/ID#: 769YY4850 (IA) Customer#: 4224396 Name: Middaugh, Gabriel Class: D ID Status: EXP Abraham Address: 2115 J ST APT 2 Audit#: 1391258 DL Status: VAL Issue Date: 10/26/2016 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 11/02/2018 CDL Cert Status: None 522402047 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 2115 J ST APT 2 Restrictions: NONE Restriction None Supplement: Date of Birth: 11/02/1984 Mailing IOWA CITY, IA Sex: M City/State: 522402047 History Information Convictions Citation Date Conviction Date ACD Explanation County ]UR 03/06/2008 05/21/2008 A20 Deferred Judgment Johnson IA OWI 03/06/2016 03/31/2016 S92 Speed (10 mph& Muscatine IA under in 35-55 mph zone) Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation JUR 03/06/2008 A98 OWI Test Failure lIA County Johnson Sanctions Type Effective End ACD Explanation Occurreg5 >� ]UR V Ca. all Revoked 03/17/2008 09/12/2008 A98 OWI Test Failure IA ) .4 Ip ...,w Suspended 09/16/2016 10/24/2016 D51 Non Payment of IA C7"< I r Child Su r+fl Pport i i Name: Middaugh, Gabriel Abraham DL/ID: 769YY4850 4In 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: ASr 8/7/2017 ili: . O. T. " ei: 171,144=14‘10/1411e49.‘ Office of Driver Services Iowa Department of Transporation Name: Middaugh, Gabriel Abraham DL/ID: 769YY4850 m J W. c .� 4:30 r rn t .