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Home My WebLink About12-126r � r 1 Amp d CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX Authorization Number y,-- /.2 -lo APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) (Office Use Only) First Middle Last 1. Name (°,(A J � " oPLppu� L_2 2. Mailing Address �Li % / _I2" (moi�_ 4 (Q 3. Telephone: Home 3 `�( gS� - �(2� Other: (l "73 3-275 % 4. Prior experience in transportation of passengers: D rn,z a cc- a S Ca /v Zr; tiJz� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A D 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? 1n C9 Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? O ✓ C Type of offense Where / f When �/1P08Q ✓t,4v, IN �7 1) (j) 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 'l2 S Type of offense Where When /V'rA ac °,> A_&it0f6v( (i„A /t -4 t� 9/27/-2niy 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) 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) d.,Wt.1d,wbadg U r,i��IZ I hereby ify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 4 6:227G) 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 Applicant Date -? - ( 3' Q Z STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by r: sly k4d'— On this 13 day of 10�SONDRAE FORT F /_ Commission Number 159781 Sp4, tY✓'� y commf�csl3r;Exglres Notary Public in and for the State of Iowa 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). SignatlAfe of Poli ephief or designee Signature of City Clerk or designee I/. Date 7- / 3 -- Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update derMmidmbadgeapp2010dm 09/2940 0(1p01i, 0 Iowa Department of Transportation Office of Driver Services (roll Free) BM -532-1121 PO Boas 9204, Des Moines, to 503DS-9204 515-244-9124 FAST: 595-239-1837 Certified Abstract of Driving Record Inquiry Date: 6/26/2012 DL/ID #: 959AA7979(IA) Name: Welsh, Christopher Lee Class: D Address: 947 BOSTON WAY APT Audit #: 6039932 CDL Med A2 Issue Date: 06/09/2012 City/State: CORALVILLE, IA Expiration 12/03/2015 ;864 522411258 Date: IA Endorsements: 3 Mailing Address: 947 BOSTON WAY APT Restrictions: Temporary Restricted A2 License Mailing City/State: CORALVILLE, IA 522411258 Convictions Date of Birth: 12/3/1978 Sex: M History Information Customer #: 1548659 ID Status: None DL Status: TRL CDL Status: DIS CDL Cert None Status: IA CDL Med None Status: Speed .: Restriction Not Valid unless Supplement: Accompanied by Form ;864 431009 Citation Date Conviction Date ACD Explanation County 3UR 11/14/2004 02/16/2005 A20 Deferred Iudgment OWI i52 IA 07/06/2008 _ 592 Speed .: _ 48 ..,,.._., IA 04/23/2011 _ .p07/25/2008 ...... ;06/22/2011 ;864 :No Insurance Card 152 IA Operating While Intoxicated Test Refusal/Test Failure Violations M 11/14/2004 Test Failure Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 12/26/2007 :415757 [IA Sanctions Type Effective End ACD Explanation Occurrence 3UR 3UR .. _m __ �..... - ..... .. _..... ....__ , Revoked 11/25/2004 05/24/2005 A98 OWI Test Failure ,. IA _ IA ._.._......._....... ..... .. .. _ .. .. .. ....... ...._. _ - .......... .. . _.......... Suspended i09/27/2011 .INDEFINITE D53 ,Non -Payment of Iowa Fine IA `IA Name: Welsh, Christopher Lee DL/ID: 959AA7979 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: p7vJal.`l1.4 20120 8 59AM Div of Criminal Investigation STATE OF IOWA Criminal Matory Record Check Request Form To! Iowa pylon of crtmind IovesllSation Support Opontlotr $ureal),!"Floor 216 E. T" Street Dee Molues, Iowa 60319 (515) 725.6066 (6f6)715.6060 Far DCX IORNo. 2915 P. 1 oa ll I1 C�V%$0C(Sl-- DCA Account Number; (ihppllaebla From!-( #5 41 Phone! Fax! k Om requU51(niv M NWp V1YIIIIIaJ.uaw, UatVame() .wvv.r-+..�.-•-••- Fint Name .5y Middle Name ftwi,a"ndeo Date of Hirth nwwm Gender(nuwwyj Social Smurity Number i,1- 01>- M 4majo ❑Female L(96 -19 - a s r 3 Waiver tnjOrarafrow Without a rigned waiver nvm the subieet of themquert, a cumpaele crtmlari hUtory ruerd maynor be rekaarbte, per Code orlown, Chapter 692,2. For comaleta crimivat history record Information, se allowcd by law, a(ways obtain a waiver d ature from the sub Oct Of the rKUCJL WaiVer $cdXW9:l hmeby are prnnluton fork .bora lagardlea *maid to e"d= o Iowa aoaw blvaly FWM dmtwichd" Dlvtrlm prClln,llal )nro,daadan (DCO. Arr "inllad Nd"r drb mnxe+n 11919ee�al_la r0ielavu1 by ft DClwybe relaued u "'owed by '&W'w. rare: ` - '(.,o WbiverSigna( As of -7 a starch of the provided name and duo of birth revealed; d No Iowa Criminal History Record fbuad with DCI Iowa Criminal History Record attached, DCI # % sU Q DCI Received Time Jul. 5. 2012 2:03PM No,2054 (DCleae01Y) .-Jul. ll. 2012 8:59AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00737502 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2012/07/11 DCI:00737502 NAME: WBLSH,CHRISTOPHER LEE POB SEX RAC MT WGT EYE HAIR SKN POB 19781203 M W 508 185 ERG BFO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L WRST CCH RECORD •*" 01 ARRESTED 20041114 No. 2915 P. 2 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE 140- 01. IA STATUTE IA321J-2 OWI TRK#: 101350401 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEX WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCRO70591 CHARGE CLASS: NON CONVICTION TRK#: 101350401 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20050216 20050701 PROBATION 365D 20050216 COMMUNITY SERVICE 258 20050216 DISCHARGED FROM 20050926 DEFERRED JUDGEMENT 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 DCS.. 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 xNVESTI(GATION w