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Home My WebLink About17-137,�tr"1111�lp�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. —2' (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 14 3. Contact Information (REQUIRED) Email: .-Ir-r`,A Cr- %r 3, ty (°Gell Phone: (All written communication sent via email) / 4a. Driver's License expiration date (REQUIRED) (O � U ` Zj Z o b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: t rlr, t -C L 52 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? YC -S Type of offense Where When 0om1 S. What happened to the charge? (Circle o Convicted ismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged With any traffic offenses in the last five years? A (� Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other l 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N() 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 th"ame(s) IVU�� c.> DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT RTWED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C F I €VIEVfZ You must apply for an individual Department of Criminal Investigation Report (form availalfle ugwn r e "t). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTAFt') { 07/2016 s APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number e C 7Rg0 issued on n7-17,-11 exnirino on ,a^ 30—'ZA?,O I iinderstnnri that H 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, CoWtef 2, of the Cit ode. (Needs to be signed in front of a Notary Public) Signature of Applicant Date </- a I -� rr»»rr»r+rrr»rr»rr»rrrr»r»rr::rrrv,r»rrrr:r»rrrrrrrrrrrrr»:+rrrr�»r»r»r:rrara»»»»rrrr»rrrrer:r�rrrrrrrrsrrrrrrr»»rrr»»r»r STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by /h) v'% , `1 _ A14 la e't:C on this y 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 �( ✓ a/�%� Signature of Police Chief or designee 1)", 1 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. X7 PcG f� zcte,dt /o Signature of City Clerk designee Dat D rrrrrr+»»r»rrmxr»rrr•rr:rrrrrr:r...»e».aa:r»r»rr.rr»rr.......�...r..r:r»ra-`rr»»».......».r»*')rrr. � rrrr» Office Use Only n n I �-- - IC) ,<r' F =- M Approved application 3 DCI reportVE State certified driving record cn Website update — aerkff IDRWBtitiocEAPPLe2oiaa�de DOC 0712016 09/,27/201'7 11:25'r'eI loxr Cab of lora City (FAX)3193382?08 P. 002002 STATE OF IOWA °'"It,',� Criminal History Record Check F Request Form Wim,. '147. lam DCI Account Numbor: 9967-F (It oppl icablo) To; Iowa Division of Criminal Investigation From:. Cab of Iowa Clty Support operations Bureau, 1" Floor P.O. Box 428 — 215 E. 7'b Street Des Moines, Iowa 50319 (515) 725.6066 Iowa City, IA. 52244 (e19)-Ic-608o Fe- -t3r9r�s--97�- Phone: Record Far: (319)339-7302 EM 6^3 a 7Q' I L`j7VIaIe ❑Female Number waiver information., Without a signed walver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For corn olpto criminal history record Information, as allowed by law, always obtain a walver signs lure from the vu hlprr „r rhp �..,.., s,., Waiver Release: r hereby give permission for the above requesting ofttoisl to conduct an Iowa cdminal history�sco dbi ock with the Division of criminal Invesdgfltlon (DCS. My criminal history data Done Ing me that It mal alned by Cl may be rclo a wlfcil by law, Waiver Signature; �—� -- Iowa Criminal History Record Check Results //�� —1 As of ' �' a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI 6cn Criminal History Record attached, DCI 9DCT nIowa initials ".; DCI -77 (08/25/10) Received Time Sep.27. 2017 11:37AM No -7540 DISCHARGED FROM 20100720 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 Y lq IOWA CRIMINAL HISTORY DCI 00842883 J NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2017/09/28 DCI:00842883 NAME: ABBOTT,ALVIN DALE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19791030 M B 511 230 BRO BLK DER IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT LF ARM CCH RECORD *** O1 ARRESTED/TAKEN INTO CUSTODY 20080814 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714.2(3) THEFT 3RD DEGREE - 1978 TRK#: IA004VN0I COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714.2(5) THEFT 5TH DEGREE - 1978 COURT CASE ID: 06521 AGCR084366 CHARGE CLASS: NON CONVICTION TRK#: IA004VN02 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20090120 PROBATION lY 20090120 SELF SUPERVISED. DISCHARGED FROM 20100720 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 Y lq N CJ [}]'� J Y AK'N ,�IADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www,iowadot.gov Inquiry 9/27/2017 Date: Customer 5394277 Name: Abbott, Alvin Dale Address: 3353 TULANE AVE City/State: IOWA CITY, IA Convictions rage 1 or / Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800532-11211 Fax: 515-239-1837 www.iowadoLgov Certified Abstract of Driving Record DL/ID #: 292AE7849 (IA) CDL Permit Class: None Class: C Audit #: 1958929 Issue Date: 07/12/2017 Expiration 10/30/2020 Date: Endorsements: NONE Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit 522454037 Mailing 1819 HOLLYWOOD CT Address: None Mailing IOWA CITY, IA City/State: 522405931 Date of 10/30/1979 Birth: EXP Sex: M Convictions rage 1 or / Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800532-11211 Fax: 515-239-1837 www.iowadoLgov Certified Abstract of Driving Record DL/ID #: 292AE7849 (IA) CDL Permit Class: None Class: C Audit #: 1958929 Issue Date: 07/12/2017 Expiration 10/30/2020 Date: Endorsements: NONE Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: EXP DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation JUR County 12/21/2014 .02/03/2015 (Improper Registration ;IA (Scott Name: Abbott, Alvin Dale DL/ID: 292AE7849 (IA) 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. N In witness whereof, I have caused my signature and the seal of the Department to be set upon this documed�at Ankeny, Iowa this date: Os= �J A C-) I r ,R%A-d licit o;`i� , 9/27/2017 ss nl IOWA `. �' CC�a�Q� E �F11\ OBNttlg.`Q- Iowa DepOffice of aRme Sriver ervies Transportation ' http://172.29.254.55/drivers/reports/customerhistoryleertifieddrivingrecord.aspx 9/27/2017