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Home My WebLink About18-027CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED, IDEN R'fgTION NO. //`` /� ffice (OUse Orily) .FBS' /04, 04- 6) fie! 0/0 APPLICATION FOR TAXICAB / MOCD PEDICAB VEHICLE DRIVER (Police Department review must be made be 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the "required" information will result in denial of the application btII, Iva ho«qcogrr � 3. Contact Information (REQUIRED) Email: t)M, w � VK� ®qt- a),co�Cell Phone: �I i 31 - 91 3 la (All written commu i tion sent via email) 4a. Driver's License expiration date (REQUIRED) a v a ;L- b. Taxicab Business Name (REQUIRED) ,Ito W C Ct C 5. Prior experience in transportation of passengers: C - ah �Driv+r ) 6 No 1- Cti� IM,,rCr,),s c� Up�o„j 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When /Ct�en,�e. Cit--, -�aays What ha�Per ed io tt i chatdi . brcl ) Z• onvlct Dismissed Deferred Suspended ea Other Have you been arrested / charged with any traffic offenses in the last five years? _i[cz Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 6 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) No 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify th ( have sued Go me by the Iowa Department of Transportati a valid rivers Iicen number ?j 10issued onJig 15 expiring on 5 0 y urrst541�that if I falsely answer ny questions in this application, that this a.a ati may be denied. I agree hat in,�iatingnis aroliication, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine arty, an"ll rds and documents relating to this application, and I further agree that, ff authorization to be a taxicab driver hs q anteito c ly at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front oDaftotav Pu"o Signature of Applicant � Date�� - ,s STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by W: I on this day of in and forhhe State of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Dri i es I' e 0 Z - `77 Sign o olice Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. f, Signiature of City Clerl or designee a •�rti�«��«-rN»��r��rH�rk�mrrti»�Nr�r�t:NrK*a��r�r��:��:�ra��w � �y Office Use Only Approved application DCI report State certified driving record Website update Clerk(TAXIDRNBADGEAPPL92014am ded.DOC Date 07/2016 Feb.21. 2018 10:25AM Div of Criminal lnvestlgation No.4136 P. 2/3 FeOm:Clty of low& City Clerk Olfla• 319 3666487 02/22/2016 17:20 0404 P.002/002 Iain STATE OF IOWA Criminal History Recoid Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E, 7" Street Des Moines, Iowa 50319 (515) 725-6066 (515) 725-6090 Fax R4 a ��sl(96 on: L 1.1t (n.rr1 DCI Account Number: " (ifapplicable) From: Cllr 01 11 Clty City Clerk'a OfKim 410E, Washin ton Street Iowa Cl , IA 52240 phone: 3191 61 41 Fax: 319-356-5497 ❑Female Witlyer11fOrtttationf 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 c m le a criminal history record information, as allowed bylaw, always obtain awaiver gi nature from the subject of the rennstt W llveP Release: r hereby give permission for the above requtaling official to conduct an lolva criminal lnvesliealton(DCq. Any cdminalhllrorydalamhcemingmerhal ismnaainlamodbydlc DCt maybe released as Waiverffl nature:i�/�'"� As of a1 �1 « a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI DCI initials DCI -77 (08/25/10) perp iv.rl Tim. f.i. 11 nhla .l,lZiDU al. Arll the Division of Criminol (oel use Only) r.r Feb.21. 2018 10:26AM Dlv of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00622510 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00622510 2018/02/27 NAME: BARRY,WILLIAM DEXTER DOE SEX RAC HGT WGT EYE HAIR SKN PGB 19670215 M W 509 220 BRO RHO MED MD ADDITIONAL IDENTIFIERS CCR RECORD *** Ol ARRESTED/TAKEN INTO CUSTODY 20000612 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 042157401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / SSA MISD / 1ST OFF - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 042157401 SENTENCE DISP EFF DAT JAIL 2D 20000720 ATT DDS SA EVAL FINE $500 20000720 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 IHE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.4136 P, 3/3 eon p1 c" ) 4�I" MEMO M 0 ca o_ D1 CIowa Department of Transportation Olive d Dtwef Services (Tdl Flee) 800-532.1121 PO Box 9204, Des Mattes. iA 50306 9204 515-244-9124 FAX: 515.2391837 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Drivqr 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: h� 2/27/2018 D. 0. lkk PIP Office of Driver Services Iowa Department of Trensporation Name: Barry, William Dexter DL/ID: 435AA6946 Certified Abstract of Driving Record Inquiry Date: 2/27/2018 DL/ID At: 435AA6946(IA) Customer #: 3350447 Name: Barry, William Class: D ID Status: EXP Dexter Address: 720 N DUBUQUE ST Audit #: 9658988 DL Status: VAL APT 7 Issue Date: 12/22/2015 CDL Status: None city/state: IOWA CITY, IA Expiration Date: 02/15/2022 CDL Cert Status: None 522451925 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 720 N DUBUQUE ST Restrictions: Corrective Lenses Restriction None APT 7 Supplement: Date of Birth: 02/15/1967 Nailing IOWA CITY, IA Sex: M city/State: 522451925 aatw e 1 History Information f Dl C7 CLEAR DRIVING RECORD Do o is C0 M N m Name: Barry, William Dexter DL/ID: 435AA6946 v Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Drivqr 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: h� 2/27/2018 D. 0. lkk PIP Office of Driver Services Iowa Department of Trensporation Name: Barry, William Dexter DL/ID: 435AA6946