HomeMy WebLinkAbout17-155CITY OF IOWA CITY
410 Iasi Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319)356-5497 FAX
t. Name (REQUIRED)
2. Address (REQUIRED
IDENTIFICATION NO.
(Office Use ly)
I12 - hE
APPLICATION FOR TAXICAB I 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 aoolication
3 Contact Information (REQUIRED) Email: ,1iv.Callowc�`jba�ww(l- C0� Cell Phone: 3IV `J67- t✓`ib
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) t /2 a /go A it
b. Taxicab Business Name (REQUIRED) ll n Cts S Ta
5. Prior experience in transportation of passengers: C', ar%
ti
O �
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this Statk;sew'5ere?�D _
(-D-< r
Type of offense Whereenr r
M
What happened to the charge? (Circle one) `C4
n
Convicted Dismissed Deferred Suspended Plead Guilty Other _
7. Have you been arrested / charged with any traffic offenses in the last five years? NO
Type of offense Where When
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? 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 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)
0712016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby cert' that I have issued to me by the Iowa Department of Transportation valid Driver's license number
.30 fa g 2 58 issued on o r /& expiring ono A0 ?oltif . 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 DS/Q ,2D(
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and swan to before me by
!Nu;yrA01
on this 4
in and for the Stale bf Iowa
day of
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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).
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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.
i9 ature of City Clerk esignee Date
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State certified driving record C-2
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As of o Ov& of the provided name and date ofbfdh invested:
No Town Ccitav+al History Reootd found with DCI
[a Iowa Criminal Hidory Record atmched, DCI # �_
DCI fnftIpIr.
Received Time Aug. 1. 2017 9:38AM No. 3648
not
ARTS Pagel of 2
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ClJ10WADOT
SMARTER I SIMPLER I CUSTOMER DRIVEN wwW'1°Wadot.g°V
Office of oriversefvldes
PO Box 9204 j Des Moines. IA 50306=9204
Phone: 515-244-9124 1600-532-11211 Fax: 515-239-1837
www.fawadot.gbv
inquiry
Data:
Customer
Name:
8/4/2017
1808601
Certified Abstract of Driving Record
DL/ID #: 302882858 (IA) CDL Permit Class: None
Class: B
Calloway, lames Michael Audit #: 9780064
Address: 3036 FRIENDSHIP ST Issue Date: 02/13/2016
City/State: IOWA CITY, rA
CDL Downgrades
Expiration 01/20/2024
Date:
Endorsements: NONE
CDL Permit Issue None
Date:
CDL Permit
522455112
Mailing
3036 FRIENDSHIP ST
Address:
None
Mailing
IOWA CRY, IA
City/State:
522455112
Date of
1/20/1968
Birth:
None
Sex:
M
CDL Downgrades
Expiration 01/20/2024
Date:
Endorsements: NONE
CDL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
Restriction None
CDL Permit
None
Endorsements:
CDL Permit
CDL Permit
None
Restrictions:
ID Status:
None
Restrictions: CDL Intrastate Only
DL Status:
VAL
Restriction None
CDL Status:
VAL
Supplement:
CDL Permit
ELG
Status:
CDL Cert Status:
Excepted Intrastate
CDL Med Status:
None
Effective _ End _ Issuing 31JR
04/30/2014 ----- • - _ 02/12/2016 —_ IIA —_---_•— - _
History Information
Accidents - Accident Involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date
3uR
Case Number
_ _ _
8/08/2013___
08/08/2013---1
--r'--'---
,IA
---�
754691
_
09/18/2015
_
IA
1879129
Name: Calloway, James Michael DL/ID: 302OD2858 (IA)
Pursuant to Iowa Code 4321.10, 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 ofFlcial 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:
http://172.29.254.55/drivers/reports/customerhistory/cerdfieddrivingrecord.aspx 8/4/2017
AK 16
a/4/2ov
Office of Driver Services
Iowa Department of Transportation
Name: Calloway, James Michael DL/ID: 302BB2858 (IA)
rage ` o1 Y
http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/4/2017