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Home My WebLink About12-0827. Have you been convicted of any traffic offenses in the last five years? Type of offense . .`'ICJ./ �.��✓ �/ N When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? A Type of offense Where When 9. Have you ever applied to bean 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) derlJie=mrmbe g 09/2010 Authorization Number % t (Office Use Only) 1 CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington street between 8 a.m. to 3 p.m., Monday - Friday.) Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX first MJ'�dle y Last % 1. Name 'e4 /7t �a�7 �,-c - <✓ 2. Mailing Address /;Z)S ZaIrG.'r t)i> 3. Telephone: Home _�/`%- S' -57,Y7 Other: 4. Prior experience in transportation of passengers: is°k 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /t,2 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense . .`'ICJ./ �.��✓ �/ N When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? A Type of offense Where When 9. Have you ever applied to bean 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) derlJie=mrmbe g 09/2010 ti I herebyc�e�t th t ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license number D 1 -7 . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 ApplicantDate - f##!ff f 1fH4HHf##RHHHHRhR#HHfHHl41Y4lHf#ifHRffIHRHMf4YH4lHiRY#H4Hf#ffRHRIHIHlHHflHflHHHtRI�FMi'Y Ir#f1Hf-f#fflHlHH44 STATE OF IOWA ) COUNTY OF JOHNSON ) l SuAscribed a d sworn to before me by Imo£ I+ �� IF 6c rC� On this t day of KELLIE K. TLIME Notary Public in and for the State of Iowa -�Mvi'3'aicu iivu iitoi �Cor�lmissi�E>�ires I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). of i Chief or designee Date of City Clerk or designee Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Hf4Y4#,,,,H...f4YY„H,,,fHIHY,,,,,,H,..fH4Ylfl4„f,,,,,,,fHH4HfHHH4H,x„f-,,,,,,,f1HfH44f.H#,HHHHHR#,HfHHHHH,,,,fef RH Office Use Only Approved application DCI report State certified driving record Website update detlN dnvbaageapp2010 dM 09/2010 Iowa Department of Transportation CM Office of Driver Services (roll Free) OM -532-1121 PO box 9208, Iles Manes, IA 50306 9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/30/2012 DL/ID #: 013SS7989 (IA) Customer #: 1112851 Name: Crawford, Keith Herluff Class: D ID Status: None Address: 1205 LAURA DR LOT 25 Audit #: 5081973 DL Status: VAL Issue Date: 03/15/2011 CDL Status: None City/State: IOWA CITY, IA Expiration 02/24/2014 CDL Cert None 522451528 Date: Status: Endorsements: 2L CDL Med None Status: Mailing Address: 1205 LAURA DR LOT 25 Restrictions: NONE Restriction None Date of Birth: 2/24/1982 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522451528 History Information CLEAR DRIVING RECORD Name: Crawford, Keith Herluff DL/ID: 013SS7989 Pursuant to Iowa Code §321.10, I, Kim Snook, 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: >. "..... %'4 3/30/2012 IOWA .: *°. D. 0. T.:�; CO 'K*4V la&r�r � 7f �� Office of Driver Services Iowa Department of Transportation Name: Crawford, Keith Herluff DL/ID: 013SS7989 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 3/30/2012 Mar. 9. 1012 11:29AM Div of Criminal Investigation Mar 00 ') z us:zsp STATEO.F IOWA Criminal HistF Record Check is Request Form. To: Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 2151:, 7'a Street Des Moines, Iowa 50319 ($IS�72S606G , (515) 725.6080 Fax J3 No. 1181 P. 1 p.l DCI Account Number: _99674 (Irepplicohle) From: Yellow Cab of Iowa City P,O. Box 428 Iowa City, U. 52244 (319)338-9777 ' Phonot Fax: (319)339-7302 1 aR1 iC aG]WI all IV wA Nrll lrNp. uuw, Last Name (mandalory) ��w.0 vuvv.. �... First Name ornwdco )' Middle Name (recommends DateofBirth(maneatory) Gender mandatory) socialSecur[ Nrtsnher(tcammendcd) o g 011fale ❑Female Waiver.lnforirration. Without a signed waiver from the subject of the request, a complr{to criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver si nature from the subject of the request. Waiver Release: l hereby give permission for the above legdesdng aalc(el to conduct rn'fowa erimiMl h)rtoryword check will, rhe Vvision of Criminal tnveeagailon(DCO. Any criminal hinary data eoncmingng/m�e%thatismnlnulnedtrytlw maybe,)e edmollo w+thyllw. Waiver Signaiare:�.CzrYk ��' 2 : Iowa Criminal History Record Check. Results (66614=1y) As of 3 a l a search of the provided name and dale of birth revealed: No Iowa Criminal History Record found with DC1 ❑ Iowa Criminal History Record attached, DCI i! DCI initio]s zh— DCI-77 (08125110) Received Time Mar. 5. 2012 3:23PM No. 0738