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Home My WebLink About13-041"l1r. -1 An ,!_;� � CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name T1 2. Mailing Address � 0 r�- % / a Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle / i3 --,4I (Office Use Only) 3. Telephone: Home 3/ y 230 )-, 5 440Other: n 4. Prior experience in transportation of passengers: __I l 4 c tt / —e✓ / T,-(,<1 Oz-, v-ew- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense I I iffwir I - '01JR Where When 6. Have youee ponvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? U Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense W ere When S L 0"-q C,, -k-/ . 5-3 0^ o l d 8. Has your drivel's license or chauffeurs license been suspended or revoked in the last five years? Type of offense Where When 9. HaXe yoyever 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) ddM-& 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number L i 7 I/ !/�57a . 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 ovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) / 1 Signature of Applicant& /// I 1'244--c /L Date oC _ 7— o/—S FFFffF#f*f#f#f#11flfYR#Y+**+#+##+#+##H#+###+###+##++####+##*#*###+#*+######**###*#+*###***##**+#4e##+###+##*####f*#####*##*#***f###+#+##++##+#+* STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by -aL4 ! , 1�wrc,r—f— On this a2 day of e 1i #rm SONDRAEFORT S Commission Number 159791 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). SiZ4—z A;V� gn ture of P lice Wef or d signee ?q6..? %. ,poli 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. Signa of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update 'a-'2-7 /.9 Date d.r .idmb dg.pp2010. 09/2012 ARTS Page 1 of 1 Iowa Department of Transportation iLo Office of Driver Services (Toll Free) GM -5592-1121 PO Box 9204, Des Moines, !A 50305-9204 515-244-9124 1*0 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/27/2013 DL/ID #: 347VV2563 (IA) Customer #: 4277080 Name: Durgin, John L II Class: A ID Status: None Address: 2027 TAYLOR DR Audit #: 5346201 DL Status: VAL Issue Date: 07/05/2011 CDL Status: VAL City/State: IOWA CITY, IA Expiration 09/05/2016 CDL Cert None 522407053 Date: Status: Endorsements: N CDL Med None Status: Mailing Address: 2027 TAYLOR DR Restrictions: NONE Restriction None Date of Birth: 9/5/1966 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522407053 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 07/28/2009 09/18/2009 -515 Speed _ i .IL 03/28/2012 _ 03/30/2012 .S92 'Speed 52 SIA , Name: Durgin, John L II DL/ID: 347VV2563 Pursuant to Iowa Cade §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: ""•:;p% `4 2/27/2013 •IOWA `8�'s S% fR111111%R S� % Office of Driver Services Iowa Department of Transportation Name: Durgin, Jahn LII DL/ID: 347VV2563 http://172.29.254.55/drivers!reports/customerhistorylcertifieddrivingrecord.aspx 2/27/2013 No. 4120 V. �/J Feb. 21. 2013 2:08PId Div of Criminal Investigation 3793382708 p•2 Feb 'rr w vv.cvp ,euuw Cab ui iuwa %,'w . STATE OF IOWA Criminal History Record Check Request Form TO; Iowa Division of Criminal Investigation SupportOperar(mu Bureau, I" Floor 215 L 7"Street Desmolumlowa 50119 (514,125-066 (515)7M6080 Fax DCI Account Number: ^9967-F OfapattcIW) From: Yellow Cab oflowet City P.O. BoX 428 Iowa City, ie,. 52244 (319)33&9771 Phone• Fax., (319)339-7302 s am requesting an Lova cnmmm nt 11 Last Name maedon"l raccv,u ..� . �••• Fires Mame (amAwa )' Middle Nttmo (rceomm, Wca) �b irl J~Ci�l2 Z-- Date of Birth (Cwwawy) Gender (nundmey Social1V,um/ bcr raoavreo —rl Wdiver Infprmatlorlr Without a signed Waiver from the subject at the request, a eompkk grhaiaal history record A=y not information, as allowed by low, always ba releasable, per Code of lows, Chapter 69=)For Comptek criminal hlatory•reoorO obtain a waiver signature from the rub eat of the reguct Waiver Release:faembyalvopwebsIMM f«d%ve 16 WtocondudmlowiCrim(oalbal ypmdrhwkwiWNeMbloncTCrimimt Inrafiyelion tl>Cq. Any uinnnal>,iuory rima con c by the leased as allnwdlby lYW. ww wr Stgrlatare: Iowa `Criminal History Record Check Results (00.us* Cray) As of \� l \�3 a search of the provided Mme and date of birth revealed: -Ey _ 4J ❑ No Iowa Criminal History Record folmd with DCT . l .. Iowa Criminal History Record attached, DCI #` r DCI iWaala-_�L— DCI 77 (081251) 0) Received Time Feb, 11. 2013 5:26PM No,4221) Feb.21. 2013 2:08PM Div of Criminal Investigation No.4120 P. 2/3 OCY :00569657 NAME; DURGIN,JOHN L II DOB SEX RAC 19660905 M W IOWA CRIMINAL HISTORY DCI 00569657 %ISDEMRANOR C0hVICTTDNS ONLY PAGE 1 OF 2 DATE PRINTED - 2013/02/21 HOT WG^a EYE HAIR SKN POB 507 180 ALU BLN FAR OR ADDITIONAL IDENTIFIERS TAT R SHLD CCH RECORD °1* 01 ARRESTED 19980210 AGENCY: IA0990000 WRIGHT CO SO CHARGE NO- 01 IA STATUTE IA321J-2-1 OWI IST OFFENSE TRK#: 003767501 COURT DISPOSITION AGENCY: XA099015:7 WRIGHT CO DIST COURT COUNT NO. 01 IA STATUTE IA321J-2-1 OWI IST OFF$NB$ CHARGE CLASS; MISDEMEANOR CONVICTION TRKW : 003787501 SENTENCE JAIL 2D FINE $500 02 ARRESTED 20001009 AGENCY: IA0480000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OHI 2ND OFFENSE ' TRK#: 033729301 COURT DISP06ITION AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE IA123-46 PUBLIC INTOXICATION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 033729301 SENTENCE FINE $100 COURT COSTS 03 ARRESTED 20001124 AGENCY: IA0410000 HANCOCK CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVING WHILE REVOKED TRK#: 044024101 COURT DISPOSITION AGENCY: IA0410159 HANCOCK CO DIST COURT COUNT NO- 01 IA STATUTE IA321J-21 DHTVINO WHILE RRVORED CHARGE CLASS: MISDEMEANOR CONVICTION DISP EFF DAT 19980515 19900515 DISP EFF DAT 20010501 20010507 Peb.21. 2013 2:09PM Div of Criminal Investigation No,4120 P. 3/3 TltX# : 099029101 SENTENCE PLEAD GUILTY FINE COURT COSTS DCI 00569657 PAGE 2 OF 2 DISP EFF DAT 20010109 $1000 20010109 20010109 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 A13394CE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASEDNFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS�E SUBy£CT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION