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Home My WebLink About12-173// Fir t Middl Last 1. Name (�&'7 coc� ✓�, (� 2. Mailing Address Ad ) 3. Telephone: Home 3/Other: 4. Prior experience in transportation of passengers: ��m.��{ ,{/' l ni� G•,b Co✓rnr�,r 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /VO 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? n/0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? No Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A/O Tvoe 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) 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) cier aeidnWadg 06/2012 Authorization Number r (Office Use Only) �1r"111 � h +a how" 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 (319) 356-SO40 (3 19) 356-5497 FAX // Fir t Middl Last 1. Name (�&'7 coc� ✓�, (� 2. Mailing Address Ad ) 3. Telephone: Home 3/Other: 4. Prior experience in transportation of passengers: ��m.��{ ,{/' l ni� G•,b Co✓rnr�,r 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /VO 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? n/0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? No Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A/O Tvoe 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) 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) cier aeidnWadg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license naimber 2MGr —S . 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 w& 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 STATE OF IOWA ) COUNTY OF JOHNSON ) tNbscribed and sworn to before me by C K-ly— LS . On this A JT day of 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). a0 - Date 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. fffY4f##a##*%#**4+*a4R1fl4Y4Yff#'F;F%***4****R+R 441fNHY###%***44*R*****44*#f4f14ff4ffaffllflfYYf Y4YfY*4tr+a#***4f*44H44%444f%fYYff#%#%***%t*4%a Office Use Only Approved application DCI report State certified driving record Website update clad ,dni b.dgeapp2010.d 06/2012 r� Iowa Department of Transportation 1 C8 Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/10/2012 DL/ID #: 769YY6550 (IA) Customer #: 3953016 Name: Daniels, Chad Everet Class: D ID Status: None Address: 2410 LAKESIDE DR APT Audit #: 6197014 DL Status: VAL 3 Issue Date: 08/08/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 01/02/2017 CDL Cert None 522406762 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2410 LAKESIDE DR APT Restrictions: NONE Restriction None 3 Date of Birth: 1/2/1983 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522406762 History Information CLEAR DRIVING RECORD Name: Daniels, Chad Everet DL/ID: 769YY6550 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: .......... :.vi��y 8/10/2012 IOWA ?'' 0. P. PF QRIR S��` Office of Driver Services ''k.�„- Iowa Department of Transportation Name: Daniels, Chad Everet DL/ID: 769YY6550 J Aug.16. 2012 3:07PM Div of Criminal Investigation hNo.9343 PP. X2/3 am.11" .. rCa'nlmnraA:JHI:iAOrY ble,ord Check DCIAccountMmber: 4 oa ' - fopplkeb(c) Tw Iowa 4Vly(oh or Cdntinal YnVestkAt(oh Pro= CZCY Oj' 10M. C137 Support Operattons Bureau, I"Floor CITY CT.ERK'g o)?FICE 215 E. 91, SireoE 10 s. As r�ClfoN S CRS6T besXpIn" Toria 4 50319 (915) 725.6866 MTA MW (515) 725-6880 IrAYi 70> -JA 52240 phondi RJ9—ASF—SOlG1 VAX, RiQ.-.45F.—S4g7 Ianrre ues anYoWa41`ImYnalrristet I7ocord4haokon: ' Y astlYpme (ntenanlery l rst�ame (me datd,y) Middle, MO (tecommmacd) � a t�! � Ve.C•4.� .Arlie Ol'�9k`t%(m¢nde(o Cxehrier mnndeio ) SOCfaY S�CCI'4'i 1VU)nTt Cr rcwmmendei ;�a{v®!r tefortnatiolr:WithoptAslgncdts'aiYerll•omthesubjcctaPthorngnesF,aroMp(eEeo1•Iro;nalhletol•yreeordmnynoC het•ol8pyp(7le,per Code ofTbWA)Chapier692.2.Torco'orinl(ndlhtstolyrecord(NfotYnattott,asallowddbytOWilp(trAys ![�Yer-�CiB(t58, Cheubyallo perMlu(en for lhvo esling oll` 1 tonducf an Tow$cdmina1B15[ory(eco(d �hecktrilh lhapNialomofC,Im(naf Ynvcsagatton(pC�, Myottm(nalAfelorydvmdonwm(n i Ism�fn ud6 ihoi)Otmey6(ot�cicescdpsnlfcivaQDyldw. 1 I 1 .,.. .u,w.io uv a. Y �AWVA XWORALO ere onlp) '��/a Aso£ a seesch o£lhsDO pxoVIde,d name and date o£bi thaeveaYed; a EJ NOIbwaCiiminaIMstoryRecordfound withr)CT yah o goo 7} gip: 7orrmGrJminalrllstptyRecord sttaclied,bC](# �03�/ ;. .d _ > bCl:iraifials "'�/ r 1.0 3eceived Time Aug. 10. 2012 3:45PM No. 1179 Aug.16. 2012 3:08PM Div of Criminal Investigation No,9343 P. 3/3 IOWA CRIMINAL HISTORY NON CONVICTION DCX:00635759 NAME: DANIELS,CBAD EVERITT DOB SEX RAC NGT WGT EYE HAIR 19830102 M W 600 155 BLU BRO ADDITIONAL IDENTIFIERS CCH RECORD I++ 01 ARRESTED 20001207 DCI 00635759 PAGE 1 OF 1 DATE PRINTED - 2012/08/16 SKU POB MED XA AGENCY: IA0520200 IOWA CITY PD CHARGE NO- Ol IA STATUTE IA124-401 POSE OF A SCHED 2 CONT SODS TRK#: 054380601 ARST DISP: ADULT ARRAIGNMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE - SR COURT CASE ID: 06521 SRCROS7896 CHARGE CLASS: NON CONVICTION TRK#): 054380601 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010516 PROBATION lY 20010516 DISCHARGED FROM 20020124 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUXLT, 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 DCX. 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 INQUXRY. DIVISION OF CRIMINAL INVESTIGATION