The URL can be used to link to this page

Home My WebLink About17-152CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. Z —7— / 5Z_ (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 First Middle Last 2. Address (REQUIRED) 1c ola t.. CoK T:tz• Ez C�WT,4 Ay In 3. Contact Information (REQUIRED) Email: 3 l ps 2v ®�� •) Cell Phone(Jj9 `r9*j"3 (AII written communication sent via email) 4a. Driver's License expiration date (REQUIRED) Sj/y/cloao b. Taxicab Business Name (REQUIRED) A&,j OA, QP n� A 044 5. Prior experience in transportation of passengers: '7'7 ) -""T y /)a W C'Mb 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsEamere? /1)a Type of offense Where C;1 ::r --4 -c — w r �rn What happened to the charge? (Circle one) � � Fri Convicted Dismissed Deferred Suspended Plead Guilty` `6ther=- 7. Have you been arrested/ charged With any traffic offenses in the last five years? T Type of offense Where When F-- G What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead Guil 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 provide the name(s) 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 - APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number W!7xr J�nl m issued on !Iz 1,W expiring on I understand that if I falsely answer any questions in this application, that this application may be denied. I agr a 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 -M. 11,Qa t, Date / i STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ten:=M q�_AQ 13 in and for on this \3 _ day of 10 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 O_Q>�_ Signature of Police Chief or designee //,132 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 ature of City Clerk or esignee Date 7n w Office Use Only =<r o Approved application w r - DCI report State certified driving record Website update Deck/rAXIDRN&4DGEAPPL92D14am ded.DOC 07/2016 AC Iowa Department of Transportation Office d Dmw GlaIvim (Toll Free)) 32.1121 PO ami am, Dm Momm, A5MO&S12114 515-2449124 FAX:615.239.1837 History Information Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 11/6/2017 DL/ID #: 627XX6064 (IA) Customer #: 2375713 Name: Phelps, Gilbert Allan Class: A ID Status: None Address: 1206 E COURT ST Audit #: 9079785 DL Status: VAL zone Issue Date: 05/13/2015 CDL Status: VAL City/State: IOWA CITY, IA Expiration Date: 05/14/2020 CDL Cert Status: Non -Excepted 522403234 Intrastate Endorsements: Motorcycle CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: Corrective Lenses, Restriction None CDL Intrastate Only Supplement: Date of Birth: 05/14/1958 Mailing IOWA CIN, IA Sex: M City/State: 522403234 History Information Convictions Citation Date Conviction Date ACD lrxnlanati.. Count IUR 02/05/2013 02/25/2013 S92 Speed (10 mph & Buena Vista IA under in 35-55 mph zone Name: Phelps, Gilbert Allan DL/ID: 627XX6064 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: 11/6/2017 IOWA D. 0. T. Office of Driver Services Iowa Department of Transporation 11Nov. /. 101/;; 2:08PM, Cab0iv of Criminal Investigation STATE OF IOWA, Criminal History Record Cheep: Request Form To: Iowa DIVIAIon of Crlmlonl lovestl8etlon Support 00erollons Bureau, l" Moor 115 2.7" Street Dee Moines, Iowa 50319 (615)'715.6056 (515)715-6080 Fax I am renllnct)nd an Ir1\Va Crlminvl K7tvMnLR-en.A M,.wl...w. (FAX)31s330o. — h 168 P. r 1002/002 DCX AoaountNumbert-9907-1? • (tfappllwblo) From- _ Xd1gj0abofXavvoCity P.O. Box 428 'Iowa City, IA. 37,244 (319)338.9777 Phone- Fax- (319) 339.7302 Lost Name mandato) First Name (maridil2w Middle Name (wommondea (DCI use only) As of a searoh of the provided name and data of birth revealed- Date of Blahtmmdete Gender mandat Sootal Securl Number teeommandt %h// V%Ye Amide ❑FemaleVirS _7 —/ Wd1Vdr1f(Jorm4110n: Without d signed wlilver from the sub)eot of the request; a domplete erhi linat history reodrd may net be reienrable, per. Collo of Iowa, Chapter 691.1. For eomolate'grlmlnal history record InibIrmallou, as allowed by-law, always AbtslnawelveraI ns"uretrom.ehesubeetofEhare uest. WaWr Jtdida.4611 herdW liv0 peontulm fol ole Wove toglasdA8'ep101A1 to ecoduct as Imva edminol hlmityseeord checkwlth she blvldon of CdtnInel' Ibvasdladen (DCI), Any oftnal Wery dssa conodmlne me that Is maintained bythe 13CI miy be veleand u allowed by Imv. MY&Signal" r�-td a.& A AMAJAMA a A L.LJOWL V recur 'AICGa\1�OJaa (DCI use only) As of a searoh of the provided name and data of birth revealed- ='< No No Iowa Criminal History Record tbund with DCI -A ;. P1 ❑ Iowa Criminal History Reoord attoohed, DCI # r. J +'i ;:, w DCI initials A -C.. f... w 0 DCI -77 (08/25/10) Received Time Nov. 6. 201.7 1:41PM No -9604