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Home My WebLink About13-286 Authorization Number 13 -2? • 1 (Office Use Only) .111 ASCU APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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) 356-5040 (319) 356-5497 FAX First Iddl Last 1. Name I ''C,vt f C rr C C vl-,SJw CJ< 2. Mailing Address )i C G''t,t c our r- 3. Telephone: Home l 6"61 11..6o7 2-- Other: 4. Prior experience in transportation of passengers: pc,1'1‘-)7 Cvo%c h eo1-cs * SC ti cai 80- € st,„Hier 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? Il/() Type of Offense Where When rr1� U '4 • - ) kn ` c 7. Have you been convicted of any traffic offenses in the last five years? `/ -P S Type of offense Where r When I fiQ o bt y fiC-fr.( I To nsan ,j-fr Z l 3 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?A/v 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerkltaxidrivbadg 03/2013 y a I hereby certify__ I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nun ber i I D 64/ 1L_ . 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 ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by \rc-.v: S S . . On this U day of Notary P lic in and for the State of Iowa "7/3( H 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). /2/1y,3 Si nature of Police Chief or designee 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. 1�L2r /4N(../1 Sign re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 I/2"(width)and 51/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp2010.doc 03/2013 iliDec. 24. 2013 10: 22AM ,Div Criminal Investigation hNo,T91179 PP. el VYV. Iv. LV IJ II • JV11111 VllrV1411, Vllr VI 1V.IV Vll i .• STATE OF IOWAwith /A `) Criminal History Record Check (,':: ., i_ :j LC 'A/1 Request Form `' :: rrnn • DCI Account Number: 4002—E (if applicable) • To: Iowa Division of Criminal InYostigation 'From: CITY OF IOWA CITY Support Operations Bureau,1d Floor CITY CLERK'S OFFICE 215 E.711'Street 410E WASHINGTON STREET Des Moines,Iowa 50319 ' (515) 725-6066 IOWA CITY, IOWA 52240 (515)725-60R0 Fax Phone: 319-356-5041 Fax: 319-356-5497 I ant requesting an Iowa Criminal ilistoyllecord Check on: Last Name (mandatory) Sint Name naeadmory) Middle Name(recommended". � Criis7r)cit 1 rcw1 '5 S Cal Date of Birth(mandatory) ' Gender(mandoloty) Social Security Number(recommended) 3- ' 7LE /Male ❑Female 1 '176-kc—Zio2 Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,pet Code of Iowa,Chapter692.2.Forsompietg criminal history record information,as allowed by law,always obtain a waiver sienotute from the subject of the request Waiver Release:I hereby give permission for ilio ab Mt requesting ofticlal to conduct an Iowa criminal hlnoryrecord cheekwith the Division of Criminal Investigation(DCI). Any criminol history dela concemingma that Is tneini Xaa:bafelened as allowed bylaw. .....�., Waiver Signature: �.� ,�,_V opu.oQ,cer Il Iowa/Criminal History Record CheckResults (DCI ore only) As of J2 2443 , a search of the provided name and date of birth revealed: kNo Iowa Criminal History Record found with DCI❑ Iowa Criminal History Record attached,DCI# DCI initials X DCI-11(08/25/10) Received Time Dec. 18. 2013 11 :49AM No. 8603 f Iowa Department of Transportation 4, Office of Driver Services (TdI Free)800-532-1121 PO Box 9204,Des Manes,(A 50306-9204 515-244-9124 FAX:515-239-1637 Certified Abstract of Driving Record Inquiry Date: 12/18/2013 DL/ID#: 261DD6492 (IA) Customer#: 4653591 Name: Comstock,Travis Scott Class: B ID Status: None Address: 11 CONEFLOWER CT Audit#: 5846575 DL Status: VAL Issue Date: 03/09/2012 CDL Status: VAL City/State: IOWA CITY,IA Expiration 03/09/2017 CDL Cert Excepted Interstate 522406730 Date: Status: Endorsements: PS CDL Med None Status: Mailing Address: 11 CONEFLOWER CT Restrictions: Corrective Lenses Restriction None Date of Birth: 3/9/1974 Supplement: Mailing City/State: IOWA CIN,IA Sex: M 522406730 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 10/11/2012 102/05/2013 M14 !Fall to Obey Traffic Sign/Signal !Johnson JIA —j Accidents-Accident involvement Indicated does NOT mean the Individual was at fault or given a citation. Accident Date Case Number JUR 01/30/2013 1 Name:Comstock,Travis Scott DL/ID: 261DD6492 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: O•• ''''-* % 12 /18/2013 tr IOWA ' 6 a D. O. T.; eiceria yI,14e jigs Iowce of Driver of Services ansportation Name: Comstock,Travis Scott DL/ID: 261DD6492