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Home My WebLink About15-005 Authorization Numberc..-31 r 1 (45-- ace Use Only) APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday–Friday.) 410 East Washington Street Iowa city. Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) �:;�c--sem--\ �,c-,-- <--q ��<— 5— 2. Mailing Address (REQUIRED) G�.3 5 C . cc1 �cic 'C1 1-,b \ C . 3?-3\73. Contact Information (REQUIRED) Email: ,c .x. ,kr --� ,\ . co;-1\ Cell Phone:(3,`� X30-3\\C___ 4. Prior experience in transportation of passengers: \,,„4,1 \o- y cZ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �(, Type of offense Where 1 I113YIA1►t�7► 3w ttv\ 8hst uemuKtiotionwr, .f 7 �\cc^Sr- k �c c-�\�? r7"Vr? ,n,,>.-imp;, 1. 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? ' — Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? C: Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1G 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 therne(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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereby yortify that I have issued to me by the Iowa Department of Tran3por atinn , 6nauffeur's license number . 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 Date 1— !'n YOU ARE NOT V.EILID TO RIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. AF.ithorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA COUNTY OF JOHNSON ) • Subscribed and sworn to before me by Je ti ilA e--1 • C.01- . On this CP, v day of civ.\Are s ��:t�y• 1 VIVI 4 WOW Notary Public in for the State of Iowa Ell! StycommeMgnnExpires µufT SrA729428 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). Signature of Polic- ief 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. i .i74471/ 7� 'Lt/ / 'Signaturof City Clerk or designee bate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application _ DCI report State certified driving record Website update Clerk/fAXIDRNBADGEAPPL92014amended.DOC 09/2014 �Z�Dec. 30. 20140,10_ 13AMCae Div ofCriminal Investigation (FAX)31933B21°. 7°84 P', .13,002 ,�rr , <,,, `,>.:. STATE OFRecord {{.yy.[[IOWA , ��.,�•.'.h;4i� HistoryRe i C -"••jr. , Ej� , .1 k~' Criminal co d Check 1t.::J". “.:'�F�` :;� a'-,,, �� t��jri Request Form . w' = "~ ' �► Ad? Ig1sir+ur1i s:'. r-1 DCI Account Number: 9967-F inapplicable) Tot Iowa Division of Criminal Investigation p'rorn1 Yellow Cab of Iowa City Support Operations Bureau, I''Floor P.O.Box 428 215 E. 7th Street • ;Oes r+:oia+e , Iowa 50319 Iowa City, IA., 52244 (515)725.6066 (515)'725-6080 Fax (319)338.9777 • • Phone: ' Fox: (319) 339-7302 I am reguostlna an Iowa Criminal History Record Check on: Last Name (ntehdelary) _ First Name(mandatory)_ 1Vliddle Name(recommended) ' cam" — - \--&-'1/4-1-c-\c\ ._. .. Date of Birth (mandatory) Gender(man'd'atory) 'Socinl•Securi Number (rcoornmonded) \ - \� J�1yXale Dome \1 . 7 - `-'`1"l :. Waiver Ir;formatiorr: Without a signed waiver from the subject of the request, a complgte criminal history record may not be rolcasfble,per Code of Iowa,Chapter 692,2. For complete criminal history'record Information,as allowed by law,always obtain a waiver Al;nature from the sub set of the re.nest, Waiver Release;I hereby give parmIsiton for the above requeertng official to oonduot en Iowa criminal history record cheek with the Divlsion of Criminal Investigation(DCI). Any criminal history data concerning me That Is maintained by the DCI clay b0 reler&std as eflowcd by law, L Iowa Clrimin tory Record Check Results (DClusconly) As of.122:3V r7" , a search of the provided name and date of birth revealed; ::--) `' �. Q No Iowa Criminal History Record found with DCI `,-+`2 Cu l'. �i • k Iowa Criminal history Record attached, DCI# 7 '�/ /? . ). �'• C.,.)r 11 DCI initials ,1_,0 13CT-77 (08/25/10) Received Time Dec. 29. 2014 10: 15AM .No. 6996 . Dec. 30. 2014 10: 13AM Div of Criminal Investigation No, 7084 P. 2/3 IOWA CRIMINAL, HISTORY DCI 00549419 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2014/12/30 DCI:00549419 NAME: CARTER,JERMEL DONYEA DOB SEX RAC HGT WGT EYE HAIR SKN POB 19751108 M B 506 150 BRO BLK MBR IN ADDITIONAL IDENTIFIERS TAT R ARM CCH RECORD *** 01 ARRESTED 19970414 AGENCY: 1A0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401 .5 POSSESS SCHEDULE I/ MARIJUANA TRK#: 032247601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK{: 032247601 SENTENCE DISP EFF DAT FINE $300 19970814 02 ARRESTED 19981236 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708-2A(2B) DOMESTIC ASSAULT CAUSING BODILY INJURY TRK#: 032258501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA236-2 DOMESTIC ABUSE/ASSAULT/CAUSE INJ17RY CHARGE CLASS: MISDEMEANOR CONVICTION cm TRK#: 012258c01 RESTITUTION :L;.7.71 SENTENCE DISP EFF DAT C JAIL 60D 19990423 g FINE $250 19990423 COURT COSTS 19990423 PROBATION 1Y 19990423 (A) ri 03 ARRESTED 20010415 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA708-2 ASSAULT/INJURY/DOMESTIC TRK#: 100215201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA723.4 " Dec. 30. 2014 10: 13AM Div of Criminal Investigation No. 7084 P. 3/3 DCI 00549419 PAGE 2 OF 2 DISORDERLY CONDUCT COURT CASE ID: 06521 AGCR058558 CHARGE CLASS: MISDEMEANOR CONVICTION TRIO. 100215201 SENTENCE DISP EFF DAT JAIL 4D 20010824 CREDIT W/TIME SERVED 20010824 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION. BUREAU OF IDENTIFICATION 18 A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCEOF 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 ry • cn • C_ >z4 - "MI C7 G7 i--- io w III/II) Iowa Department of Transportation .. [ foe of Driver Service (Toll Free)800-532-1121 Po X30* 204.[]es Manes,1A 503Ui>JC4�t 515r244-9124 94114111110 FAX:515-230-183T Certified Abstract of Driving Record Inquiry Date: 12/29/2014 DL/ID#: 554XX0811 (IA) Customer#: 604334 Name: Carter,Jermel Class: C ID Status: None Donyea Address: 265 S CHESTNUT Audit#: 7448101 DL Status: VAL ST Issue Date: 10/18/2013 CDL Status: None City/State: NORTH LIBERTY, IA Expiration Date: 11/08/2018 CDL Cert Status: Excepted Intrastate 523179308 Endorsements: L CDL Med Status: None Mailing Address: 265 S CHESTNUT Restrictions: NONE Restriction None ST Supplement: Date of Birth: 11/8/1975 Mailing NORTH LIBERTY, IA Sex: M City/State: 523179308 History Information CLEAR DRIVING RECORD Name:Carter,Jermel Donyea DL/ID: 554XX0811 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: _ 111t 4,4 12/29/2014 t .•: .• - rr fiRI1ik�=-- Office of Driver Services r"} 1. ni Iowa Department of Transporation '+.. ` t:) L C,J Name: Carter,Jermel Donyea DL/ID: 554XX0811 -f z