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Home My WebLink About18-019� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) Address (REQUIRED IDENTIFICATION NO. )A—(7 19 (Office Use Only) 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 application 3. Contact Information (REQUIRED) Email: 14��w�Pfa�GI�=/%.cUVh Cell Phone:��y'�y�sy�r 11 written commLMication sent via email) 4a. Driver's License expiration date (REQUIRED) 0 3/Ga/`�aoaa b. Taxicab Business Name (REQUIRED) YE II& L." �r 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 4e-.5- Type 4PfType of offense Where When J V i What happened to the charge? (Circle one) Convicted.-�Dismissed Deferr Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? /'tea Tvce of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Nb 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$4me(s) /y 0 �u DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED ---- DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C+IIEF RBWEW f You must apply for an individual Department of Criminal Investigation Report (form avai(eWe;upi i regi;. (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify Ihat I have issued to me by the Iowa Department of Transportation a valid Driver's license number t 'a R 4 P6 -S issued on / -3/ -XVexpiring on ,23-0,9 - /01� . 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 Date +:rr+rrrrr++.rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr.rrrr.ererr:rsrrrrrrrrrrrrrrrrr.rr+rrrrrrrrrrrrrrrrrrrrr:rrrrrrrrrr:rrrrrrrrrirrrrrrrrerrr STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by LEL6640w/�� on this 12 day of COMM S MAYER ^ J� i m1561on Number 7228 _ 6�„ e^ My Com �a �' Notary Public and for the Stat of Iowa 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 Driv 's license 03-07— -/8 (�. a �1'7 Sigpffure of Police Chief or designee a2 -/3-/6 Date 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 Clerk dt designee Date rrrrrrrrr.rrrrrrrrrrrrrrrr»rr,.rr...e.rrr.rr.raarrrr:rrrrrr:r......+.m,.rrrrr:rrr:rr...r.rr.re....r.+r+.rr.rrrrrr...e...y.........rr«.rr.r.r Office Use Only Approved application DCI report State certified driving record Website update OvkrrFXIDRN ADGEAPP 92014�dWDOC 07/2016 N O_ C Cfl D� w C-) <r- m � � Q 7F tV OvkrrFXIDRN ADGEAPP 92014�dWDOC 07/2016 C4iUVVADOT wmviowadot. ov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 www.iowadot.gov Inquiry Date: 2/2/2018 Customer #: 4528084 Name: Burke, Jerald Alan Address: 5335 UTAH AVE SE City/State: LONE TREE, IA 527559798 Mailing 5335 UTAH AVE SE Address: Mailing LONE TREE, IA 527559798 City/State: Date of girth: 12/14/1983 Sex: M Convictions Certified Abstract of Driving Record DL/ID #: 076AA8815 (IA) CDL Permit Class: None Class: D CDL Permit Issue None Date: Audit #: 2511858 CDL Permit Expiration None ""11 Date: Issue Date: 01/31/2018 CDL Permit None Endorsements: Expiration Date: 12/14/2022 CDL Permit None Name: Burke, Jerald Alan DL/ID: 076AA8815 fin) L<? Restrictions: —a Endorsements: Chauffeur ID Status: EXP Restrictions: NONE DL Status: VAL. Restriction None CDL Status: None Supplement: I— CDL Permit Status: ELG M CDL Cert Status: None CDL Med Status: None History Information :Itatlon Date Conviction Date ACD Explanation JUR County )2/04/2015 03/09/2015 M14 Fall to Obey Traffic Sign/Signal WI Name: Burke, Jerald Alan DL/ID: 076AA8815 (IA) Pursuant to Iowa Code 4321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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: 2/7✓2018 IOWA 2'r D. 0. T. ' ""11 Iowaansportation Iowa DepartmenteoflTr N O m Name: Burke, Jerald Alan DL/ID: 076AA8815 fin) L<? M —a 1 --i C7C.J I— 'O a M 1 1 Cn FeS- 9• 2018 2:13PM Div of Criminal Investigation No -3386 P. 2/5 FL. —,,y Clerk vniaw ... ......1 02/07/2010 114:116 oi77 ".002/002 am SWAT'S, OF IOWLA. 0 Criminal History Record Cllecic Request Form To: Iowa Division of Criminal Investigation Support Operatlons Bureau, l"Floor 215 B. 7" Street Des Moines, Iowa 50319 (515)725.6066 (SIS)77,5-6080 Fax �c First Name fa" -Tc�G�& DC1 Account Number: (ifepplicable) From: Cil Oflows Cit, City Clerk's Office 4101+" Washington Street lows Ci , IA 52240 Phone: 319-356-5041 Far: 319.356-5497 INlyIale ❑Female V 7y-06 -/-Tly riarver[nJorMrtffon: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code allows, Chapter 692.2, For co. molete criminal history record information, as allowed by law, always obtainwaiver signature from the subject of the reauest. Wa{Verlielease:Ihuebygive permissionfwlheabovernpio;ne.,ra,ll( sov,ewe.,smr..«;,,,;,,,srnxveyrzrorecn«xwrNthe Division afCrminal esugaoon DCS, Any criminal hisbrydela W"A%ing me shat is mainlaincd by the DCl may be released as&flowed by law. 7 Waiversirflafure: s As of It ------- __ __. ..th revealed: No Iowa Criminal History Record found with DCI uy. Iowa Criminal History Record attached, DCI 1" DCI initials DCI -77 (08M/10) Received Time Feb, T. 2010 2:05PM No.3120 (DC) ase way) 0 O uy m l 60 ce'cl+ -' f.Y '- r <. -0 M Ln Fe,b. 9. 2018 2:13PM Div of Criminal Investigation DCI;00674305 NAME: BURKE,OERALD ALAN BURKH,GBROME BURKE,JRRALD EURKB,JERALD ALAN BURKE,JERRY GEROME DOB SEX RAC 19531214 M W ADDITIONAL IDENTIFIERS SC R HND IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCT 00674305 PAGE 1 OF 3 DATE PRINTED - 2018/02/09 HGT WGT EYE HAIR SKN POB 606 165 BLU BRO MED IA 02 ARRESTED/TAKEN INTO CUSTODY 20020810 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA321J.2(2)(A) OWI -10T OFFENSE TRW M00015701 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: TA321J.2(A) OPER VEH WH INS (OWI) / 1ST OFF COURT CASE ID: 07701 OWCRO24770 CHARGE CLASS: NON CONVICTION TRW M00015701 SENTENCE DISP EFF DAT DEFERRED =GEMENT 20021126 PROBATION 1Y 20021126 COMMUNITY SERVICE 40H 20021126 No. 3386 P. 3/5 N O O *c-, n CCH RECORD *** 01 ARRBSTED/TAKEN INTO CUSTODY 20020615 AGENCY; IA0160000 CEDAR CO SO CJ CHARGE NO- 01 IA STATUTE IA321J.2 OWI IST OFFENSE Om N TRK#: 052390901 D c_n COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / 1ST OFF COURT CASE ID: 07161 OWCRO17143 CHARGE CLASS: MISDEMEANOR CONVICTION TRW 052390901 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT SUSPENDED JAIL 20D 20020920 JAIL 30D 20020920 FINE $1000 20020920 PROBATION 365D 20020920 02 ARRESTED/TAKEN INTO CUSTODY 20020810 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA321J.2(2)(A) OWI -10T OFFENSE TRW M00015701 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: TA321J.2(A) OPER VEH WH INS (OWI) / 1ST OFF COURT CASE ID: 07701 OWCRO24770 CHARGE CLASS: NON CONVICTION TRW M00015701 SENTENCE DISP EFF DAT DEFERRED =GEMENT 20021126 PROBATION 1Y 20021126 COMMUNITY SERVICE 40H 20021126 No. 3386 P. 3/5 N O O *c-, n m TI 4m CJ m Om N Q D c_n Feb, 9. 2018 2:13PM Div of Criminal Investigation No.3386 P, 4/5 DCT 00674305 PAGE 2 OF 3 DISCHARGED FROM 20040217 DEFERRED JUDGEMENT 03 ARRESTED/TAKRN INTO CUSTODY 20020926 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA123-47 POS9 ALCOHOL UNDERAGE IA STATUTE IA321J.2 TRK#: M00037301 n COURT DISPOSITION OWI 2ND AGENCY: IA070015J MUSCATINE CO DIST COURT C7 COUNT NO- 01 IA STATUTE: IA123.47(2(-B --yry • Y POSSESSION OF ALCOHOL UNDER AGE - 2ND OA SUBSEQ OFF COURT CASE ID: SMCR025039 Ca CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: M00037301 SENTENCE DISP EFF DAT FINE $200 20020926 04 ARRESTED/TAKEN INTO CUSTODY 20021127 AGENCY: IA0020200 DAVENPORT PD DRIVING WHILE BARRED --HABITUAL OFFENDER CHARGE NO- 01 IA STATUTE IA321J.21 DRIVING WHILE REVOKED TRK#: M00475002 TRK#: 902223001 COURT DISPOSITION AGENCY: IA052015J SCOTT CO DIST COURT COUNT 140- 01 IA STATUTE: IA321J.21 N DRIVING WHILE LICENSE DENIED OR REVOKED COURT DISPOSITION COURT CASE ID: 07521 AGCR255344 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 902223001 MUSCATINE CO DIST COURT SENTENCE DISP EFF DAT SUSPENDED JAIL 120D 20030129 JAIL 120D 20030129 FINE $1000 20030129 PROBATION lY 20030129 OS ARRESTED/TAKEN INTO CUSTODY 20050403 AGENCY. IA0700000 MUSCATINE CO SO oN CHARGE NO- 01 IA STATUTE IA321J.2 n OWI 2ND C7 rn --yry • Y TRW M00475001 -'-r Ca CHARGE NO- 02 IA STATUTE IA321.561 DRIVING WHILE BARRED --HABITUAL OFFENDER �rn TRK#: M00475002 N COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT V_7 COUNT NO- 01 IA STATUTE: IA321J.2(B) Feb, 9. 2018 2:14PM Div of Criminal Investigation DCI 00674305 PAGE 3 OF 3 OPER VEH WH INT (ONI) / 2ND OFF m COURT CASE ID: 07701 OWCRO31499 ;.—i CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: M00475001 DRUNK DRIVING SCHOOL C? -G �C-) SUBSTANCE ABUSE EVALUATION r SENTENCE DISP EFF DAT FINE $1500 20050607 PRISON 2Y 20050607 OWI PROG COURT DISPOSITION j AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 02 IA STATUTE, IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID; 07701 OWCRO31499 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: M00475002 SENTENCE DISP EFF DAT FINE $500 20050607 PRISON 2Y 20050607 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. , e DIVISION OF CRIMINAL INVESTIGATION I$_fC1 No. 3386 P. V/ p m ;.—i w _ C? -G �C-) — W r <(` M q.�p.q f . 9 Q ^y` N