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Home My WebLink About17-134 .s- IDENTIFICATION NO. 17 _1 3 V t 1 ' t 1 (Office Use Only) 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 East 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 /first 1.•le Las 1. Name (REQUIRED) 1' Qru/ 2. Address (REQUIRED) �,�a ' ' �lL,� !_ /iso _.. se4. /' 3. Contact Information (REQUIRED) Email: Cell Phone:3)7 -90 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED a f /__ b. Taxicab Business Name(REQUIRED) . i i „ r 141 5. Prior experience in transportation of passeng rs: Fl"r V71�q ` ( I kQ, /1" J 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? ype of offense CC- - 4 _ sidultagre When. Iry - / .' •SII.' _Ft What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPlead Guilt Other 7. Have you been arrested/cjigl.cie.d.oith any traffic offenses in the last five years? _5' .e of offers e • Where When '11,11 .,'i _Aar 1 . 1:9, W-, #.141/ ' #.141, 0' r , �% ,�lQmPh in 35-55- �r ( 10 f la_ What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended lead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please proytdeill narrrelst A/04hetile - DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERII IED'-,r 1 DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIE1 r.� 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 hereb if. t a I have issued to me by the Iowa D art ent of Transporta is a all. Driver's license number �- issued on 0J5 expiring on / . I understand that if I falsely a swer any questions in this application, that this app c on may be denied. I .:gre: 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 ► or Date4/4/Za47 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by 3 f 2.` V0( 'f O v on this 7 4 day of ConwriNion WNW nos . Notary Public in!arfor the State of lo$a • I-t Iii & 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). C� 7 Exp. ation d- e . Dri er's license `-1/ ,-C L 9/2, Si atur- of Po*c• Chief or designee y/ 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. ,1 9/21// 1 Signature of City Clerk : designee . Date ************************************************************************************************************************************************ Office Use Only . Approved application 'y �• s� DCI report `D State certified driving record Website update t ' Clerk FAXIDRIVBADGEAPPL92014amended.DOC 07/2016 f Stitt of Iowa Division of Criminal Investigation 1W,,°, !till? / ` 215 E.7th Street ''c, 4� t Des Moines,Iowa 50319 ,�, IOWA Phone: 515/725-6066 Fax: 515/725-6080 =., ►� Al r - Iowa Criminal History Record Check .;,, Walk-In Request NO Your name: /r ' , t- , Address: '!, • .t . - I IC. City/State/Zip: > 0 j Fill in all shaded areas. Phone#: 3/1- { 'e[ �� Requesting an Iowa criminal history record check on: Last Name Apel lido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) tlerrtki - Date of Birth Fechaa Nacimiento(mandatory) ender Genero(mandatory) social ecurity Number(recommended)_ 0 79 9 ,Male ❑ Female fig`f- 42-:t5017 'Waiver Signature Firma(If the request is on yourself',please sign. If the request is on someone else,write N/A.) 741—allit:V161400-- _ Results DCI USE ONLY As of CI• ( q - n' , a name and date of birth check revealed: =a ❑No record found • ARecord attached DCI# 7 q 310 (40 � V ; DCI initials d-. r. . . Receipt 0 Number of requests $15.00 per last name=Total amount$ 15 � Method of payment: cash money order check# MasterCard or Visa ,.Last 4 digits) C7 Cardholder's name ...s.:C", �=--two DCI initials -C N r .0 tTt -o rn Credit Card # Exp. Date r5 y N 0 ria DCI-83 (09/09/10; Revised 10/1/10; form reviewed 08/11/14) 4 IOWA CRIMINAL HI6TORY DCI 00299366 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2017/09/19 DCI:00299366 NAME: MORROW,BRET ALLEN DOB SEX RAC HGT WGT EYE HAIR SKN POB 19640403 M W 602 345 GRN RED MED IA ADDITIONAL IDENTIFIERS SC CHEST CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19830115 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708-1 ASSAULT TRK#: L23192401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-1 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23192401 SENTENCE DISP EFF DAT JAIL 30D 19830413 COURT COSTS $9 19830413 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 N O rn -� -Q ' "l E-rt a C:7 i Page 1 of 2 COICSWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN wwW.iowadot goV Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 I 800-532-1121 I Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry 9/21/2017 DL/ID #: 075AA1630 (IA) CDL Permit Class: None Date: Customer 3617557; Class: A CDL Permit Issue None #: Date: Name: Morrow, Bret Allen Audit#: 8981567 CDL Permit None Expiration Date: Address: 916 20TH AVENUE PL Issue Date: 04/04/2015 CDL Permit None APT 2 Endorsements: Expiration 04/03/2020 CDL Permit None Date: Restrictions: City/State: CORALVI LE, IA Endorsements: Tank, Passenger, ID Status: None 522411423 Double/Triple Trailers Mailing 916 20TH AVENUE PL Restrictions: Corrective Lenses, CDL DL Status: VAL Address: APT 2 Intrastate Only, No Class A Passenger Vehicle Restriction None CDL Status: VAL Mailing CORALVI LE, IA Supplement: CDL Permit ELG City/State: 5224114 3 Status: Date of 4/3/1964 CDL Cert Status: Excepted Intrastate Birth: Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation ]UR County 11/08/2012 12/12/2012 S92 Speed (10 mph &under in 35-55 mph zone) IA Linn 11/09/2016 12/07/2016 N82 Improper Backing IA Johnson Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 02/08/2011 I IA 617539 Name: Morrow, Bret Allen DL/ID: 075AA1630 (IA) N o =a Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa DepartngEnt orAranspMion, do hereby certify that I arrl the custodian of the records held by the Office of Driver Services, that this 11..i ge and accunatei.copy of an official record currently in the custody of said office, and that I have been authorized by the Director7gfithe igya De�ertRient of Transportation to so certify. — i --�;7 rii In witness whereof, I have caused my signature and the seal of the Department to be set upon this doGnerCrat Arlen, Iowa this date: �= 'J •:::..c.7. N 9/21/2017 Page 1 of 1 41140 iowA DOT SMARTER I SIMPLER I CUSTOMER DRIVEN wwvv.iowadot.go\ Iowa City DL Station Eastdale Mall 1700 S First Avenue Iowa City, IA 52240 Statement Receipt: 45591595 Customer Information Office Information Name: Morrow, Bret Allen As Of Date: 9/21/2017 1:29:18 PM Address: 916 20TH AVENUE PL APT 2 CORALVILLE, IA Location: Iowa City DL Station 522411423 Phone: Fax: Email: Attached Customers Name Morrow, Bret Allen Transaction Type Description Amount MISC Finance Transaction - Morrow, Bret Allen $5.50 Product Amount Voided Sale of Records- Certified $5.50 Total Due: $5.50 Payments Payment Method Payor Payor# Number Amount Tendered Cash Morrow, Bret Allen 3617557 NA $5.50 — ca TotaL?ender: $5.50 -4 -7 emsors &St Bad r. $0.00 -0 i , 9/21/2017