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Home My WebLink About13-274 Authorization Number -2 Li r 1 (Office Use Only) ll ; it i CITY OF IOWA CITY lay 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) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name pit V_()be 1 l��a�• 2. Mailing Address 55 7 (7 S/F /---z) 4/ 6 2- w C S LA SZ - `( c 3. Telephone: Home 319 - - Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where _ When o t' v I — .e,J 199a /2,0,(k . 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? �1() Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 200 ck 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? }\ Type of offense Where When 9. Have you ever applied to be ani Iowa City taxi driver using a different name? If yes, please provide the name(s) \I 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) derk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number \Jc\ A C 161 ?j . 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 \2 - 5 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by �c ( ca c.( . On this „.5--Lk.. day of JaQ r k-t i EU mac! ) Ox). S � \ f4 WENDY S.MAYER Votary Public i nd for the State Iowa Z CAMMIssion Numoer 7c942a 44 • My Commission Expires ow —t-13-1 ************************************************************************************************************************************************ 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). �j/ f2 S / Si ature /Police Chief or designee / " Dat 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. Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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 UerkRaxidrivbadgeapp2010.doc 03/2013 Nov. 18. 20133L2:34PMQad Div of Criminal Investigation (FAX)3,933e2?N0. 2466 P. , 1J2/0O2 • • • • ;i STATE OF IOWA - ,'• "tmta'''ti 's`. Criminal History Record Check '� ` •c:fn �, ;elRequest Form . . ,t? nfi' DCI Account Number: _ 9967-F (Wepp cable) To; Iowa Dlvblon of Criminal lnvntigation From: Yellow Cab of Iowa City Support Operations Bureau,1"Floor P.O.Box 428 215 E.7'1 Street Des Mgines,Iowa 50319Iowa City,IA. 52244 (515)7254056 , (515)725-6080 Fax (319)338-9777 • Phones • . Fars (319)339-7302 • I am requesting an Iowa Criminal History Record Cluck on: 1 . Last Name(mandatory) ,First Name easemorsi-- ' Middle Name(tooemmtinded) Great SiC0 +IL. ' 1 2clae't.i— Date of Birth(m.ndeloy) Gender(nandarury) ' I •Secial•Security Number eicammcndad) Nov 241 rogiMelo • OFemale Dema4i34- 54 - 2VP % ( Waiver Information:Without a signed waiver from the subject of the rawest;a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2,For complete criminal hlstory.record Information.as allowed by law,always ' obtain awaiverdune tuna from the sablectofthe request. I • Waiver Release:)hotebyglva pamina too u tha shows mgn.Jsm eomold to eondnet lova'criminal alar/Mooed oho&with the Mahlon nrcdmind lavutlgulon(DCO.My criminal history dam oanaaidng me tet n maintained by 11th Del mgbe' tonal as allowed bylaw. Waiver Signature: -- 1----• •r • • • Iowa Criminal kfistortr Record Check Results (netneaonly) As of VA S//3 ,a search of the provided name and dl to of birth revealed: • • 0 No Iowa Criminal history Record found with DCI • • Iowa Criminal History Record attached,DCI# r;Z 6 I&-9 DCI initials ' DCT-77(08/25/10) • Received Time Nov. 13. 2013 2: 37PM No. 2062 Nov. 18. 2013 2: 35PM Div of Criminal Investigation No. 2466 P. 2 IOWA CRIMINAL HISTORY DCI 00261899 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OP 1 DATE PRINTED- DCI:00261899 2013/11/15 NAME: GRAU,SCOTT ROBERT DOB SEX RAC HGT WGT EYE HAIR SKR POE 19551124 M W 601 168 BLU HRO MED IA ADDITIONAL IDENTIFIERS SC BACK CCH RECORD *** 01 ARRESTED 19800129 AGENCY: IA0770300 DES MOINES PD CHARGE NO- 01 IA STATUTE IA321-201 ONVUI TRK#: L17524201 COURT DISPOSITION AGENCY' IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA321-201 OMVUI CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: L17524201 DRUNK DRIVING SCHOOL SENTENCE DISK. EPP DAT PLEAD GUILTY 19800418 PROBATION 1Y 19800415 DEFERRED SENTENCE 1Y 19800418 AN ARREST WITHOUT DISPOSITION TS 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. DIVISION OF CRIMINAL INVESTIGATION Iowa Department of Transportation r Office ofDriverServices (Tull:Free).-532-1121 P4 Dox.92D4,Des Moines,IA 31M9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/7/2013 DL/ID#: 139AC1873 (IA) Customer#: 3383405 Name: Grau, Scott Robert Class: D ID Status: None Address: 590 FOSTER RD APT B2 Audit#: 2759031 DL Status: VAL Issue Date: 11/18/2008 CDL Status: None City/State: IOWA CITY, IA Expiration 11/24/2013 CDL Cell None 522451527 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 590 FOSTER RD APT 82 Restrictions: Corrective Lenses Restriction None Date of Birth: 11/24/1955 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522451527 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 04/01/2009 ;05/05/2009S92Speed 3�Iohnson iIA ,,.. 01/30/2010 ,04/09/2010 iS92 ;Speed !Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/14/2012_ a 703032 .d IIA _.1 08/24/2013 !754528 + , Name: Grau,Scott Robert DL/ID: 139AC1873 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: • s.wvy 4� . 4114 =p .• ; 11/7/2013 fi IOWA .rt:D. O.T ;Vj - ,,4' xo Driver Services Name: Grau,Scott Robert DL/ID: 139AC1873