HomeMy WebLinkAbout18-052CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 3S6-5497 FAX
Last
1. Name (REQUIRED)
IDENTIFICATION NO. 1 L> --O S-Z—
(Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday)
Failure to complete the "required" information will result in denial of the application
2. Address (REQUIRED) 3 06) 21 Z7K 4 Griz `A
3. Contact Information (REQUIRED) Email: A 6 IcA 5-0 C 7
4a. Driver's License expiration date (REQUIRED) Z- T-
b.
b. Taxicab Business Name (REQUIRED) / � LL O[t/ '%l
Middle
� 2G
/ (J t—
Ivn9' 4- 'rO�Cell Phone: 3/ G/ - S-60 _
sent via email) 0 ? 3 8
7Z-
0 0
5. Prior experience in transportation of passengers: 5�e ✓ i ✓Y me, 4/ Oct
C-/
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? �-t 6
Type of offense
Where
When
What happened to the charge? (Circle one) rn
M
Convicted Dismissed Deferred Suspended Plead Guilty 2�her3 11=1
7. Have you been arrested / charged with any traffic offenses in the last five years? cn
r
Type of offense
What happened to the charge? (Circle one)
Where
Convicted Dismissed Deferred Suspended Plead Guilty
When
Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
Where
When
;'0
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
0
SIGNATURE
04/2018
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
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).
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
`lo % YY / �s 21 issued on O//i3/'se£�1Qg on zz o I understand that if I
falsely answer any questions in this application, that this appli�tio may be denied. 4 agr(fa that irt 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 authorization to be a taxicab driver is granted, to comply at all
times with all of the provisio s of Title 5, Chh/aptteer2, of the City Code.�NNeeeeds to be signed in front of allotary Public)
Signature of Applicant
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by �f ri C� C,. A� J L e.v, on this . L day of
LAM....a ZeIS
wENDY S. MAYER o ry Publi and for the S e of tW. !Z—
a
= 0
1 have reviewed this application, DCI report, and the State certified driving record of this applicant avgZetermined that
there is no information which would indicate that the issuance would be detrimental to the safety, walth orovelfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration ate ve license
s Z // P
SignatLKe.9f Po ice ehief or designee Dafe
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.
Of
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Date
QeddTAXIDRN64DGEkWL92018amended.00c 04Y2018
Iowa Department of Transportation
Office d Dnlrer Ser ees (Toll Feel 800-532-1121
PO Boa SIM, Des U01flies, IA 50306-9204 515.2444124
FAX- 515-230.1837
Certified Abstract of Driving Record
Inquiry Date: 4/25/2018 DL/ID #: 701YY1753(IA) Customer #: 2857327
Name: Madden, Patrick Class: D ID Status: None
George
Address: 3009 12TH AVE SW Audit #: 1549858 DL Status: VAL
APT 102
Citation Date
Conviction Date
Issue Date:
01/13/2017
CDL Status: None
JUR
City/State:
CEDAR RAPIDS, IA
Expiration Date:
11/22/2024
CDL Cert Status: None
IA
04/04/2017
524041460
S92
Seed
Johnson
IA
Endorsements:
Chauffeur 3
N
CDL Med Status: I�e
Mailing Address:
3009 12TH AVE SW
Restrictions:
Corrective Lenses
RestrictionN
APT 113
Supplement: �n
Date of Birth:
11/22/1950
�-e N
Mailing
CEDAR RAPIDS, IA
Sex:
M
--ln
rn
City/State:
524041459
-Cm
i
Q
History Information
f
cn
Sr
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
JUR
05/03/2013
05/30/2013
M42
Improper Lane
(changing lanes
Johnson
IA
04/04/2017
04/06/2017
S92
Seed
Johnson
IA
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date
Case Number
JUR
05/03/2013
737766
IA
11/03/2015
887389
IA
05/02/2017
980954
IA
05/07/2017
987758
IA
Name: Madden, Patrick George DL/ID: 701YY1753
Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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. _
Mor.27. 2018 2:33PM
•0612512018 od;l/reaOWCab Div of Criminal Investigation
(I'A)V93382noo 8051 D. j, '
r•tw[1002
STATE OF IOWA
Criminal history Record Check
Request Form
To: Iowa Division orCrlmina(lnveatlgatlon
Support Operations Bureau, 111 Floor
215 E. 7' Street
Des Moinw,lowa S0319
(515)725.6066
(515) 725-6080 Fax
am MQuesdna an
DCI Account Number: ,9967-F
(irapplleaeta)
Prom: Yellow Cab of Iowa City
P.O. Box 428
Iowa City, IA. 52244
Phone; (319) 3389777
Part; (319)339-7302
,®Male ❑Femaje
rrarver'Vortfiationr Without a signed waiver from the subject of the request, a complette crWOzi history record spay not
be releasable, per Code of Iowa, Chapter 692.2. Por complete criminal history -record inform
subject of s{lioa, as allowed by jaw, always
obtain a waiver aiadature ham tAa the raauwt
Waiver ReLease, I hereby give pmnkslon roc tha ebovo requesrina OMclal w cenduei on low u(minal history kemokd check wllh thgDivisioo arCriminal
Invsnlgation(DCO. Any ervnina) history deu�methmIsBmakultiW[q/yA60.ClmaybnrelWad mowebyl�%�
WaiverSfvnaturr• COMMZor "1"4 Lt". ,&/1, _ �it��l ter
.
(= we only)
As of a1 l g, a search of the provided tuime and date of birth
revealed -
NO Iowa Criminal History Record found with DCT
O
Iowa Criminal fiietory Record attached, DCI
DCI inidals,_
q=
='
- -
_,
DCI.17 (08/25/10)
RectIvell Time Apt, 25. 2018 9:05AM•Mo. 7886