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HomeMy WebLinkAbout17-156P/ l CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. / —7 —% 61O (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 3. Contact Information (REQUIRED) 4a. Driver's License expiration date (REQt b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa (AII sent via email) 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? !AI//U 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? Type of offense Where When 9. Have you ever 8pplied to be an Iowa City taxi driver using a different name? If yes, please provide thplame(s) l r) o DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STA" DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE You must apply for an individual Department of Criminal Investigation Report (form (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARIW Dz 07/1016 i A0PLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issyed to me by the Iowa epartm t of Transportatjg a id Driver's license number ]�� ii�Zz6 issued on f / /Z expiring on GGl 2A) oj. 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 offTitle 5, Cjhapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant s W� Date ) )IZC6 /7 YY###111N#1N#NIMH!!!!llNllHfllfNflNlflNf!#f#lfN1eYYY#NRYN#Y##NNY###N}N###H1flNNlfNNHlfllflHlf!!lNlNlflfllNNf#H!N##1 STATE OF IOWA ) COUNTY OF JOHNSON ) tj sworn to before me by C ( . 1, t 5 L j C o .,J&,_ on this Z day of SA in and fc the State of Nfif**INN*1N**N4*N11Nf#N#R1,#1#N###N##i9#iii####4N##4144NN#1NN4f*1N1N4i-R##N##1Mtit**N##hYt###*N######N##N##NNf#f4#Ni#NNi 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 Signature of Police Chief br 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. Sig ature of CityCler or designee D to f!Y*H**if*N1N1N#N1NHN11H11H*111HYf4*YN**1f*NNNNIINH*M*NH#N1HYfHf'M'11fH*11f*H*fi*f *1f 11fh*11N11NNf1fl1NN1fNNHff Office Use Only Approved application DCI report State certified driving record Website update Gerv/TAXIDRNa55oceAwLe201aaffe�ded DOC 07/2016 N v o-� *C -)o in C7'C N rn me iy cm m Gerv/TAXIDRNa55oceAwLe201aaffe�ded DOC 07/2016 Nov.17. 2011 10:56AM Div of Criminal Investigation 11/16/2017 13:06Yel low Cab of Iowa City STATE OF IOWA Criminal History Record Check 4) Request Form Tai Iowa Division of Criminal Investigation Support Operatlons Bureau, I" Floor 215 E, 7° Q-(reat Das Malnes, Iowa 50319 (916)725-6066 (515)725-6080 Fox I nm r4ouaatlne an Iowa Criminal Nismm Aennrd Check nn - No.6624 P. 2/3 (FAx)3193382708 P.0t13/003 DCI Account Number; 9967-F �- (Ifaprlldallr) Froml yellow C oflowa City P.O. Box 428 Iowa City, IA. 52244 (319)333.9777 Phones. Fag: (319) 339.7302 Last Name mandato First Name mandato Middle Name rewmmendad) Ccn in Curll5 )bM Date of Birth (nnudom Gender mandmo -W" 9oolal 9eourl Numbermaommoaded) 17, 10% ) qb I.`aMale ©Female I y ?4 Maluerinformarfan: Without a signed waiver from tho subject of the request, a dorriplete critnioel history record may not be releasable, per Code of Iowa, Cheplar 692.2, Forcomalete criminal history record Information, as allowed by law, always obtain a weIver al nature from the aub let of the re uear. Walver,telease: i hemby live pannisiIon for the above rctiumint Mill[ to con dual an loin criminal hlttoryrecord cknk with the Dlvhion orCr(mllul tnvculgnion(W). Any ariminilhltiory dile eon"trnintrne IIs me Wned ythlPCT maybe m1medesdlowedbylaw, WaIVBr Signatrlri — — —F Iowa Criminal )History Record Check Results A3 of) )•7 —I 7 a search of the provided notuo and date of birth revealed; ❑ No Iowa Crlminal History Record found with DCI u j— Iowa Criminal History Record attached, DCI # DCIlnitials DCI -77 (08/25/10) n. _ , r.__ ,,_.. ,e IA,1 f. 10Dll AI_ nin0 (DCI ace only) C2 Nov.17. 2017 10:56AM Div of Criminal Investigation IONA CRIMINAL HISTORY DCI 00641422 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - DCI :00691422 2017/11/17 NAME: CONDON,CURTIS WILLIAM DOB SEX RAC MGT WGT EYE HAIR SKN POB 19871210 M W 511 225 14A2 BRO LGT IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20050901 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124,401 POSSESSION OF MARIJUANA TRK#: 029262901 ARST DISP: ADULT ARRAIGNMgNT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 SRCR076179 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 029262901 SENTENCE FINE $100 02 ARRESTED/TAKEN INTO CUSTODY 20051128 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA713.6A BURGLARY 3RD DEGREE TRK#: 101718201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA713.6A(1) No, 6624 P. 3/3 DISP EFF DAT APPEAL DATE 20060901 20070401 BURGLARY 3RD DEGREE COURT CASE ID. 06521 FECR074923 TRK#. 101718201 SUBSTANCE ABUSE EVALUATION RESTITUTION D cj SENTENCE DISP EFF DAT cy-C DEFERRED JUDGEMENT 20060630 -min PROBATION 3Y 20060630 �C m COMMUNITY SERVICE 40H 20060630 O' TO THE CITY OF SOLON� Jy 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 Cc'� Inquiry Date: Customer Name: 10WA00T SMARTER I SIMPLER I CUSTOMER DRIVENyyyVW.IC1vV8dOt goV 11/15/2017 3995088' rage 1 of L Office of Driver Services PO Box 92041 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www.iowadoLgov Certified Abstract of Driving Record DL/ID #: 713yy8226(IA) CDL Permit Class: None Class: B Condon, Curtis William Audit #: 1485954 Address: 2801 HIGHWAY 6 E LOT Issue Date: 12/10/2016 139 + Expiration 12/10/2024 Date: City/State: IOWA CITY, IA Endorsements: NONE CDL Permit Issue None Date, CDL Permit 522402621 Mailing 2801 HIGHWAY 6 E LOT Restrictions: Address: 139 Restriction Mailing IOWA CITY, IA Supplement: City/State: 522402621 Date of 12/10/1987 Birth: None Sex: M CDL Permit Issue None Date, CDL Permit None Expiration Date: VAL CDL Permit None Endorsements: Type CDL Permit None Restrictions: None ID Status: None NONE OL Status: VAL None CDL Status: VAL CDL Permit ELG Status: Type CDL Cert Status: Excepted Interstate CDL Med Status: None History Information Operating While Intoxicated Test Refusal/Test Failure Violations t Occurrence ACD Explanation �____—_ .___ ...._ --TA-6T- 02/20/2006 Afil U� ndel�'1-AltohOl Content .02 but Ilse than .08 JUI'� County O SIA x Accidents - Accident involvement indicated does NOT mean the individual was at faufto[givs a ciEBnOn. Type citlent Date JUR Case Number �r a m /21 12/21F/2013 ',IA 775942 Explanation JUR LR Sanctions A Name: Condon, Curtis William DL/ID: 713yy8226 (IA) i 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. T 11/15/2017 Type Effective End ACD Explanation JUR Occurrence JUR Revoked 03/03/2006' .05/02/2006 A61 Under 21 -Alcohol Content .02 but less than .08 :IA _ IIA Name: Condon, Curtis William DL/ID: 713yy8226 (IA) i 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. T 11/15/2017 Page 2 of 2 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: x IOWA D. 0. T. Name: Condon, Curtis William DL/ID: 713yy8226 (IA) k 4 11/15/2017 P�wida.rl Office of Driver Services Iowa Department of Transportation 11/1VIM 7 N d C? gin�-� 5cs 'n� � r M 0 CR i 11/1VIM 7