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Home My WebLink About13-178 r Authorization Number 13 - / 7 S 1 (Office Use Only) tri *ti"AIX II 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 e, �1op� "tit FJ'lst M le t Last 1. Name �L «7 2. Mailing Address //O 6a/rfr C t.)7 .IA 52311 3. Telephone: Home J'/ _3,71 -301q Other: 4. Prior experience in transportation of passengers: -7 y�rc w.'+l, /� J? fi Gp/01 C Co, y¢wr 6,4 ?allow ('GJ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When /v - 7-/z 6. Have yoy been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? !✓o Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Ain Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1< Type of offense / Where When FR:�urc �o �,e1y C�:IOf .S[� �-I l-r+�� /O-/c.102 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) /vO . 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) clerkftaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number LS . 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?nd a recordsnd documents relating to this application, and I further agree that, if a license is granted, to comply at all times ••,all of he pfovisio• of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) /�` Signature of Applicant I.,/ Date I':n) • U STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by �.a "7"-Y. .- Z)a n . On this \ s r day of • Notary '►.lic in and for the Sta e 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). S ature 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. �/ z..c Signature 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 Only Approved application DCI report State certified driving record Website update clerMaxidrivbadgeapp2010.doc 03/2013 ' ARTS Page 1 of 2 Iowa Department of Transportation 433 IIillr IOtHce of Driver Services (Toll Free)800-532-1121 PO box 9204,Des Moines,IA 50306 204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/15/2013 DL/ID#: 769YY6550 (IA) Customer#: 3953016 Name: Daniels, Chad Everet Class: D ID Status: None Address: 110 GOLFVIEW CT Audit#: 6745167 DL Status: VAL Issue Date: 03/05/2013 CDL Status: None City/State: NORTH LIBERTY, IA Expiration 01/02/2017 CDL Cert None 523179715 Date: Status: • Endorsements: 3 CDL Med None Status: Mailing Address: 110 GOLFVIEW CT Restrictions: NONE Restriction None Date of Birth: 1/2/1983 Supplement: Mailing City/State: NORTH LIBERTY, IA Sex: M 523179715 History Information Accidents -Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number • JUR 10/15/2012 ,707650 IA Sanctions Type Effective End ACD Explanation Occurrence]UR JUR Suspended 10/03/2012 12/09/2012 psi ,Non-Payment of Child Support IA IA , Name: Daniels, Chad Everet DL/ID: 769YY6550 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: `vgttCi o"ii .. • 4!'4, 8/15/2013 al. IOWA ; *, :¢; ?oy etao CFtf OR1YEAs owOfficeof Driver Department of Transportation sportation http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/15/2013 "OF Poet, State of Iowa 1D t //4- „� Division of Criminal Investigation 4t-ik orf ow'r1-7:1.1 t- I i t... I • 215E7t"St Vit. �a F.; 7c Fa- IOWA 1-` Des Moines IA 50319 Ph.515-725-6066 Fax 515-725-6080 $ �'" e'' is ZZ y l o�,c. y s�rr 'Ss � oy p��`�@ Iowa Criminal History Record Check er"�ty Walk-In Request Your name ( pyL',��.,.,�:qj5 Address /1(/ 4o/ ti1 e,.) G-F City/State/Zip /AJo1-414 /.,6..s.-)-y ..TA fail -7 Fill in all shaded areas. Phone# 11(7 331 5011 Requesting an Iowa criminal history record check on: Last� Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) a / wl,S (LA Eve..rd4 Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number (recommended) 1/4/a.r. lei Male OFemale L/c -C OOa 13 0 Waiver Sign urejF/(ma(If the reques is on •o rself,please sign. If the request is on someone else,write N/A.) Results °"USE ONLY As of 2 - a o ` /3 , a name and date of birth check revealed: ❑No record found / Record attached,DCI# 6 3 S 76? __ ci, DCI initials Receipt Number of requests 4 x $15.00 per last name=Total amount$ 1 5-b 0 Method of payment: cash ❑money order CI check# ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials I4AL Credit Card Number# Exp.Date IOWA CRIMINAL HISTORY DCI 00635759 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2013/08/20 DCI:00635759 NAME: DANIELS,CHAD EVERITT DOB SEX RAC HGT WGT EYE HAIR SKN POB 19830102 M W 600 155 BLU BRO MED IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 20001207 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 FOSS OF A SCHED I CONT SUBS TRK#: 054380601 ARST DISP: ADULT ARRAIGNMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE - SR COURT CASE ID: 06521 SRCR057895 CHARGE CLASS: NON CONVICTION TRK#: 054380601 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010516 PROBATION 1Y 20010516 DISCHARGED FROM 20020124 DEFERRED JUDGEMENT 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. DIVISION OF CRIMINAL INVESTIGATION