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Home My WebLink About12-2657. Have you been convicted of any traffic offenses in the last five years?v S Type of offense Where When dja 8. Has your dt4ver s license or chauffeur's license been sus ended or rev edin the last five yeaFs7- Type 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) derkA.,d,,,b dg 09/2012 Authorization Number 1--), —S r (Office Use Only) —4 771►. � y�®��11 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 52240-182(r _) 356-50 J�ces It /P (319) 356-5497 FAX FirstM' dle L 1. Name 2. Mailing Address D� 03 co�Ir' K ��L� ��,�t 0 3. Telephone: Home Other: 4. Prior experience in transportation of passengers: —7 ✓ 2c, r-5� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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? u Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years?v S Type of offense Where When dja 8. Has your dt4ver s license or chauffeur's license been sus ended or rev edin the last five yeaFs7- Type 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) derkA.,d,,,b dg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number .� i e A 7�,' % !�R . 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 �L 7� ##HH#FF#R4f}H}RRRlH41141l1HfH#*H**!1'Rleff'4Hf141if4iif4HfHHHHIHHHH#H#R#H}##*}f RRRR#RRR4Rk#Hk4fHfHffN*Y##!H**#H41H*4RH4R STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me b �� y 3x On this � day of 'NofaryPilb(ic in ante State owa .��zl I,k #H####*##*#***f**ff*ffH*f#*f}f#H***k**##H1ffH#1t111ft11tf11tff*###H##1k*#RR##*R#**R*#**k*#**f Hifiiffiiiff#fftff111111H1fftff##!R###Rk#*f 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). Signa ure of 171f Chief or designee /)-? /a Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. A4Ar X4-11. r>J I/- 7-10 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. fif###i#***####**RR*1RR*1k*11f*#ff'F###i*i#******RR*RkRRk}RRR}RRIRRR1f#*R1ff*11M4F###f#f#*##f4####*iRF**R#F*RR**R****RRR*R*#RRff1RM1f##f*f#i*** Office Use Only Approved application DCI report State certified driving record Website update derk/"driAmdga pp2010dao 09/2012 Nov. 6. 2012 11:54AM Div of Criminal Investi;ation 0cl,31. 2012 1;31 PM City Clerk — City of Iowa City brixa inax,JE gto>r'y Ror-Ord Check lRepat Form To: xolvabtvlsionofWInIVallnvaxttgot(oN Support OperallonsAut'onv, I"VZOV 216.2, 1'4 Streot bnsNialnas,Iowa 90319 (sls) 7za•6a6Q (515) 725-6090 fax No, 2950 P. 4/5 No, 2975 P. 2 DGTAcooltntilumBer: QPapplfegEYo) Frolnf r•J`,�TC (tF' TOTJ'A CIT4' CITY CLI3$ g 01,21C$ 4io m. 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D1 DO hl. 4Dal a a Iowa Department of Transportation Office of Driver Services (Toll Free) WO -532-1121 FO Box 9204, Des Moines, IA 5030f -92N 515-244-9124 FAX: 515-239-1837 Inquiry Date: 10/30/2012 Name: Coolidge, Archibald Cary III Address: 2103 KEOKUK ST APT 8 City/State: IOWA CITY, IA 522407103 Mailing Address: 2103 KEOKUK ST APT 8 Mailing City/State: IOWA CITY, IA 522407103 Convictions Certified Abstract of Driving Record DL/ID #: 153002748 (IA) Customer #: 4550686 Class: D ID Status: None Audit #: 4781741 DL Status: VAL Issue Date: 10/28/2010 CDL Status: None Expiration Date: 11/04/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: Left Outside Mirror Restriction None Date of Birth: 11/4/1959 Supplement: Sex: M History Information Citation Date Conviction Date ACD Explanation County µ 3UR 10/06/2008 ,11/02/2008 .W.-._... M14. Fall to Obey Traffic Sign/Signal 52 "IA i 1_1//330/2009_ _ _ 12/30/2009 _ _ .Speed (10 mph & under In 35-55 mph zone) _ 52 IIA 030/2010 05/13/2010 592 Seed 52 :IA Name: Coolidge, Archibald Cary III DL/ID: 153802748 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: - ••:.�/V4 10/30/2012 IOWA ¢' ). 0. T. `BIIIeg Office of Driver Services �aZ� M.,- Iowa Department of Transportation Name: Coolidge, Archibald Cary III DL/ID: 153882748