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Home My WebLink About18-004CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1 82 6 (319)356-5040 (319)356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) 3. Contact Information (F IDENTIFICATION NO i (Office Use nly) 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 apolication First AAi.4.11- 4a. Driver's License expiration date (REQUIRED) 1 Q h k A /)l Z. ZQ�' b. Taxicab Business Name (REQUIRED) Chi `7 5. Prior experience in transportation of passengers: A r11 P% 4,10 % Yw5, ovetle, lVe, 4pfwvlS I'll ( Wtfh �J i�Ok?/A j2b4Y-5g oto iG 4,-;10 . Ce -4 it a9c 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Ye s what happened to the charge! (Circle one) (Convicted) Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? YP S Type of offense Where When What happened to the charge? (Circle one) to <Co_n_v7ic7jt0 Dismissed Deferred Suspended Plead Guilty-;. fi(per .. u..) 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five,years��tH,+ Type of offense Where When i en 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 l► APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Driver's license number Z�� GCiG l S L issued on V61 IC expiring on 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 d_h,277YYYi4� A/Lo $Tq i Date // 1// �r Hf1Yf lf}1Hff llf 1f f 411Hf}1H!!f!ll11ffflHOff}}ffHffllf}ffiYflftlff fF1fHH1H11fif fifYff yr}HHlllffHfl-k}1HflffY}}H!!lllff f ff11fH1Hff1H STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to efore me by � on this �_1 �� day of try Public in and fortFe of Iowa ZCZ90918QwnN Dacciwwo� c A3N10 3NIlSILIHO ff •111fffefffef1f11f1ff1ff 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 1112-1 -2 1::) Signature of Police Chief or designee Da e 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. (/ Signature of City Clerl r designee / Date > 11f11f}11ffHfff11H1HfifHltlfHHflllfHlfY-11HH1flfl111f}};fH1H!!f!!ff}}Off}ffflfy-lyfllffHlH 1f!lIiHHH Approved application DCI report State certified driving record Website update aeA/TAXIDRN94DGEAPPL92014am ded.DDC Office Use Only .7 i 07/2016 a 4. 2018 9:35AM Div of Criminal Investigation No.99h8 P. 2/8 Cion. --- ....----: 01/02/201a le:ou nate r.uu2/002 STATE OF IOWA Criminal History Reagd Check 0 Request Form To: Iowa Division of Criminal Invesli(;aflon Support Operations Dureou, 141 Floor 215 E. 7" Street Des Moines, Iowa 503I9 (515)725-6066 (515)725.6000 Gas I am requesting an P A N'F ///2/C9 THoMIqS DO Account Number; ZfDOZ-+ (if applicable) _ From: Cltvoflowacity City clerl OfOffice 410E. Washington Street Iowa City, fA $2240 Phone: 319.356-5041 Fax, 319-356-5497 ®Male 13Female 1) IqN1Z-Z-- 9 8- s'- 9 g-- P 8 WtriVer In,%f mflflon. Without a slgned waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 6922. ForoC mnlete criminal history record information, as allowed bylaw, always obtain a waiver signature from the sublect of the •nnn.ee PaiVer Belease: l hereby give pemlission for the above tequcnil g o)aciel to conduct an losve criminal history rewtd check with the 1)ivlsi".o1`Q;minal Invatigation (ncl). Any criminai history data concerning me that is maintained by the DCl may be .leased as allowed by law. Weiver Signature: Iowa Criminal Histoa Record Check Results t loClus�nly) As of ' y ' a a search of the provided name and dale of birth revealed; No Iowa Criminal History Record found with DCT r.:.�ft Wl Iowa Criminal History Record attached, ))Cl # 3 !O 2 ZScr;i.' C":=) fn I DCI initials r DCI -77 (08/25/10) Received Time Jan. 2. 2018 4:34PM No -2190 pan. 4. 21Jltl 9 JhAM Uiv of Criminal Investigation No. 9M r, in IOWA CRIMINAL HISTORY DCI 00370225 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2018/01/04 DCI.00370225 NAME: BANE,THOMAS DANIEL BANE,TOM DOB SEX RAC HGT WGT EYE HAIR SKN POB 19690112 M W 511 175 BRO BLK FAR IA ADDITIONAL IDENTIFIERS CCH RECORD t+t 01 ARRESTED/TAKEN INTO CUSTODY 19871227 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L33479301 - CHARGE NO- 02 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK#: L33479302 CHARGE NO- 03 IA STATUTE IA723-4-1 DISORDERLY CONDUCT TRK#: L33479303 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479301 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $25 19871227 COURT COSTS $20 19671227 COURT DISPOSITION o AGENCY: IA052015J JOHNSON CO DIST COURT "- COUNT NO- 02 IA STATUTE: IA719.1(1)A �4x INTERFERENCE W/OFFICIAL ACTS q— CHARGE CLASS: MISDEMEANOR CONVICTION771 TRK#: L33479302 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 " FINE $10 19871227 r> COURT COSTS $20 19871221 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA723.4(1) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479303 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $10 19871227 Ja+n, 4. 1U18 9:36RM Div of 0imioal Investigation DCI 00370225 PAGE 2 OF 4 No. Md Y. 4/S COURT COSTS $20 19571227 02 ARRESTED/TAKEN INTO CUSTODY 19590507 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L33479401 CHARGE NO- 02 IA STATUTE IA714-2-5 THEFT STH DEGREE TRO: L33479402 CHARGE NO- 03 IA STATUTE IA719-1 INTBRFERENCE WITH OFFICIAL ACTS TRK#: L33479403 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479401 SENTENCE DISP EFF DAT PLEAD GUILTY 19690505 FINE $25 19890508 COURT COSTS $20 19590508 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714.2(5) THEFT 5TH DEGREE - 1975 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479402 SENTENCE DISP EFF DAT d PLEAD GUILTY 19890627 c7 FINE $75 19890627 COURT COSTS $20 19590627 COURT DISPOSITION -- AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479403 SENTENCE PLEAD GUILTY FINE $15 COURT COSTS $20 03 ARRESTED/TAKEN INTO CUSTODY 19910607 AGENCY: XA0520200 IOWA CITY PD CHARGE NO- 01 XA STATUTE IA321J-2 Jan. 4. 2018 9 : 3 6 A M Div of Criminal Investigation DCT 00370225 PAGE 3 OF 4 OWI TRK#: L33479501 CHARGE NO- 02 IA STATUTE IA204-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: L33479502 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA204.401(3)(B; POSSESSION OF MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479501 SENTENCE DISP EFF DAT JAIL 1D 19910826 CREDIT N/TIME SERVED 7H 19910826 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 02 IA STATUTE: IA321J-2 OMI CHARGE CLASS; NON CONVICTION TRK#a L33479502 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19910926 DISCHARGED FROM 19920820 DEFERRED JUDGEMENT 04 ARRESTED/TAKEN INTO CUSTODY 19950226 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401' POSSESSION-SCH I TRX#: 014619101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-204-4—M POSSESS MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014619101 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT SUSPENDED JAIL 30D 19950330 FINE $250 19950330 COURT COSTS $75 19950330 PRORATION lY 19950330 COURT DISPOSITION AGENCY: 1A052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA665-4(2) CONTEMPT OF COURT CHARGE CLASS: MISDEMEANOR CONVICTION No, 9958 P. 5/8 0 m a — r ..An. 4. 2016 9:36AM Div of Criminal Investigation No.9958 P. 6/8 TRK#: 014619102 SENTENCE JAIL SD DCI 00370225 PAGE 4 OF 4 DISP EPP DAT 19980915 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 0 N O ARTS Page 1 of 2 C4010WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN WWW'IOWBC�Ot gOV Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1 8OD-532-1121 1 Fax: 515-239-1837 www.iowadot.gov Inquiry Date: Customer Name: Address 1/9/2018 �rrtrza; Bane, Thomas Daniel Certified Abstract of Driving Record DL/ID #: 251CCO152 (IA) CDL Permit Class: None Class: D Audit #: 9689750 5038 AMERICAN LEGION Issue Date: 01/06/2016 RD SE History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration 01/12/2021 CDL Permit None Date: 01/11/2013 City/State: IOWA CITY, IA Endorsements: Chauffeur 3 ID Status: 522409070 S93 Speed Mailing 5038 AMERICAN LEGION Restrictions: Corrective Lenses Address: RD SE Restriction None Mailing IOWA CITY, IA Supplement: City/State: 522409070 Date of 1/12/1969 Birth: Sex: M History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: 01/11/2013 CDL Permit None Restrictions: Johnson ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: 01/11/2013 CDL Cert Status: None CDL Med Status: None :itation Date Conviction Date ACD Explanation JtM County 12/10/2012 01/11/2013 M14 Fail to Obey Traffic Sign/Signal IA,, Johnson )5/08/2016 06/13/2016 S93 Speed .._, IA_.a Johntdn Accidents - Accident involvement indicated does NOT mean the individual was at fault brgivpn a citation. �y i1 [ccident Date JUR Case Number - ` .'_. 10/11/2014 IA 821287 11/07/2014 IA 825843 Name: Bane, Thomas Daniel DL/ID: 251CCO152 (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 1 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/customerhistorylcertifieddrivingrecord.aspx 1/9/2018 ARTS •""""+:v/ryr 1/9/2018 0. IOWA • t- Ccj� ' ' $`��V DRI Office of Driver Services Iowa Department of Transportation Name: Bane, Thomas Daniel DL/ID: 251CCO152 (IA) Page 2 of 2 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 1/9/2018 O http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 1/9/2018 b E{:.., mAIL 2013 JAP I I Pn t;, 1:1— i, E J H N w J W 2 1 _Q owm Uo o Kj w° y WH U TH h o QQ WR m w