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Home My WebLink About13-264 Authorization Number I I - 1 (Office Use Only) amencipqr 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 19) /i//i 5C- (319) 356-5497 FAX i AM L va14 : 'nuN First Middle Last •wc.J 1. Name �nl�m•; 2. Mailing Address /d/4'S ()est UG w OJZ 3. Telephone: Home 773 29 -.29r1 Other: 3;y - 3 3 3 /-7/6: 4. Prior experience in transportation of passengers: )1c$ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ,v b 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? .v Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ,4,,; Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ,✓o 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) ,✓'v 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) clerk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number f 5 A . 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 r�a,tf Date//-/9-/3 wENDY S.MAYER • Commission Number 729428 My Commission Expires STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me byi a n(I C n2'f'ILA rA„t . On this /Ct-tL- day of Uv0JP 144 11.e c �1 i /k vj' Notary u lic in an or the State of Iowa *.********************************...***.**********************.*************************************************************.****...*********.* 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). gnature of Police Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signat e of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2" (height)and prominently displayed to all passengers. Office Use Oniy Approved application DCI report State certified driving record Website update • derkitaxidrivbadgeapp2o,0.doc 03/2013 OIowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 PO Bax 9204,Des Maines,IA 50306 9204 515-244-9124 11111. FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/12/2013 DL/ID is 457AF2271(IA) Customer d: 5739037 Name: Coleman,Barry Joseph Class: D ID Status: VAL Address: 1445 WESTVIEW DR Audit R: 5639315 DL Status: VAL Issue Date: 11/18/2011 CDL Status: None City/State: CORALVILLE,IA 522411031 Expiration Date: 03/28/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1445 WESTVIEW DR Restrictions: NONE Restriction None Date of Birth: 3/28/1972 Supplement: Mailing City/State: CORALVILLE,IA 522411031 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR ___ _ ..._.,�___ _.__ �__ _..._.___....__.,._. .. _...,_ _. f 07/24/2012 `08/14/2012M34 Fail to Obey Traffic Sign/Signal Johnson IA I Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 03/05/2011 1621527 SIA Name:Coleman,Barry Joseph DL/ID:457AF2271 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: NNN ,,....C..p„ilii, t: • iii 11/12/2013 71 IOWA :a'f, %ti: E n: �.'.�� MD. O. T. �y hi 4e'jj1! %f Office of Driver Services yhti fin er Iowa Department of Transportation Name:Coleman,Barry Joseph DL/ID:4570.12271 Y Nov. 18. LVIJ 2013 1 : 18PM Div lof Criminal rnvestcingnat�ion� ^NoV..Y5441 VYL F. �1 1.4110 :.;,=oma .-, STATE OF IOWA . ,r� LI\` Criminal History Record Check ' . \, 4-login) _� ; 4.: � t ,Ay;,, Request Form : 1� ACI Account Number: TCX -— P (ICspplieable) • To: Iowa Division of Criminal Investigation From: CITY OF IOWA CITY Support Operations Bureau)VI Floor CITY CLERIC'S OFFICE 215 E.7'4Street 410 E WASHINGTON STREET Des Moines,Iowa 50319 (515)725-6066 IOWA CITY IOWA 52240 (515)725-6090 Fax Phone; 3 19-95 65041 • Fax; 319-'356-5497 I ain requesting an Iowa Criminal History Record Check on: ' /Last Name (mandatory) First Name(mende(ory) , Middle Name(recommended) 7 v Date of Birth(mandatory? Gender(mandatory) Social Security Number(recommended) `3` 2s- 7 a • Eltale O emale 43, S--XV/6 99 Z Waiver Information: Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa, Chapter 692.2.For complete crbninul history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver.Release:Ihereby gives permission for the above requesIing offtafel to conduct an lows criminal historyrecord check with the Division otCriminEd lnyestigetfon(DCT). Anycrhuinal history date concerning me that ismainlaincd by IheDCI may ho Monad os allowed by law, Waiver Signature: l .V 2:34.--0—L, e��t • Iowa Criminal History Record Check Results (Damn op(y) As of I I r L X -1:3 , a search of the provided name and date of birth revealed; No Iowa Criminal History Record found with DCI . . 0 Iowa Criminal history Record attached,CI) / OCT ti / DCI initials l�. J Received Timel;Nov. 12. .02013 12: 05PM No. 1877