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Home My WebLink About14-265 Authorization Number /L1 - 21 0 C 1 (Office 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 (31 _ 56-5040 (319) 97 FAX ' Last 1. Name (REQUIRED) FV \—ch_ Middle j MiMi dc_e..Q 2. Mailing Address (REQUIRED) l`-101-.0 3. Contact Information (REQUIRED) Email: Ov�1 ,)4..v .c, •\. c v-, Cell Phone: 3 lest `I"i I `d i S-4 4. Prior experience in transportation of passengers: L �. ..cv-. cc. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where nA3WMe_1 9 fkij 'sue, wti 6. Have you b en 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? d ---8c,\- ‘0e,\-\-- 4;[SC F Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 44—e-• cr vc'e _fc_„rs 4 c 9. Have you ever 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 CI—Ij F REVIEW You must apply for an individual Department of Criminal Investigation Report(form availablif upon requestl.. ti, Y; (OVER FOR REQUIRED SIGNATURE AND NOTARY) N.) F� f) 09/2014 LW e H I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number fl_.) `I-1 A-A- Li O 1 c1 . 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 \ _),,j ��`� 1* t-4_( {�' I l V 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. **********************************************************************************,.*,.****,.********....*****..*********...nk..******************** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C .k c .v , M. . C�51 . On this /c5tL\ day of ‘71-)k" )k"L-too- V--1 , c-',1 . D. tary nd rule wr 70 3_.1 AHt— Nota Publi in and for the Stale of Iowa Commission Number 7211211 • M.);Commireon Expires 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). :� /c2-10-/L/ Signat e of Po(; 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. 74ref.-e-ileu---) Tl j — /< " /YSignatuf 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 CIerI TAXIDRIVBADGEAPPL92014amended.DOC 09/2014 • Det,"' 3, 2014 12:45PM ,Div/ of Criminal �InvesVI �tingat�I � Investigation, hNo./6�475 PP . �1/2 Y ■.■ tts .•�. �IJI 7 i,,,,;;Iiir,-..;_, STATE OFIOWA �[n•r� ..i / ( ruere � o � ��c® °d Check a 4 . ly`;M1� � � nr?1e 1ifn‘ • DCI Account Number; 1/00 eV-F- of qpircabio) (iteppliceblo) To: Iowa Division of Cvlmtnal Invesilgatlon from: City of Iowa City Support Operations Bureau, 1i11'loor City Clerk's Office 215 F,711`Street 410 .Vt1as11it1-gto9Street ]les Moines,Iowa 50319 (515)72.5-6066Iowa City IA 52240 (515)725.6080 Fax - rhono; 319-356-5041 ax: 319-356-5497 I am requesting an Iowa Criminal Histow Record Cheek on; • Last Name (1,)endatory) First Name(Mandatory) Middle Name(recolno,ended) CO Q, A.4- A-k( CC4.0e_--( Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended). <Tr `- - 0 I P,',ale OFemale WailerlffOrmaflon:Without n 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 complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Releaser I hereby give permission lathe above requesting official to conduct en Iowa criminal history record check with the Division of Criminal rover ligation(DCI). Any criminal history data mooning &shit I nelotainc y the DC : be leased- • ed by few. / .11WaiverSi?gnature, ..... - -_ -- / Lev_ CrlmX>1laX �Iys$orV record Check exults ;SCI use only) As of I a search of the provided name and date of birth revealed: : c) F .-: a 1 0 No Iowa Criminal History Record found with DCI -..‹.1--;. ,T . C..) `3 -.1 4,r VIowa Criminal History Record attached,DCI i 9 _____9J�4 • - 1+.) • DCI initials _A14 - Received Time—Dec. 2. -2014— 3:41PM—No. 5360 I%('I '7.1 rr14r•)♦11III Dec;' 3. 2014 12:45PM Div of Criminal Investigation No. 6475 P. 2/2 IOWA CRIMINAL HISTORY DCI 00997589 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2014/12/03 DCI:00997599 NAME: OPAL,CHAD E OPEL,CHAD MICHAEL DOB SEX RAC HOT WGT EYE • HAIR SKN POB 19700817 M W 600 230 BLU BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT UL ARM TAT UR ARM CCH RECORD *** 01 ARRESTED 20140128 AGENCY: XA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA708.7(4) HARASSMENT / 3RD DEG. - 1989 TRK#: 1AOOIFT01 COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA108.7 (4) HARASSMENT / 3RD DEG. - 1989 COURT CASE ID: 06521 SMSM096968 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1AOOIFT01 SENTENCE DISP EFF DAT FINE $100 20140128 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 DCX. IN THE ABSENCE OF FINGERPRXNTS 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 N O CJ O � zEC) rn e L ✓ n - 7"( O ;; CJ . , I' - t) OT SMARTER I SIMPLER I CUSTOMER DRIVEN �'�! t tlV.+-d COV Office of Driver Services PO Box 9204 I Des Moines,IA 59306-9204 Phone:515-244-9124 1800-532-1121 i Fax:515-239-1837 WM.Imvadot..gov Certified Abstract of Driving Record Inquiry Date: 12/10/2014 DL/ID#: 047AA4079(IA) Customer#: 2566862 Name: Opel,Chad Michael Class: D ID Status: EXP Address: 1475 HAYDEN LN Audit#: 7406733 DL Status: VAL Issue Date: 10/04/2013 CDL Status: None City/State: NORTH LIBERTY,IA Expiration 08/17/2018 CDL Cert Status: None 523178102 Date: Endorsements: 3 CDL Med Status: None Mailing Address: 1475 HAYDEN LN Restrictions: NONE Restriction None Date of Birth: 8/17/1970 Supplement: Mailing City/State: NORTH LIBERTY,IA Sex: M 523178102 History Information Convictions Citation Date Conviction Date ACD Explanation County RJR 03/28/2012 05/01/2012 ;F04 -Seat Belt Violation Johnson IA 05/18/2012 07/02/2012 IF04 Seat Belt Violation ;Johnson IA 08/10/2012 09/06/2012 B20 Driving While Suspended,Denied,Cancelled,Revoked Johnson IA Sanctions Type Effective End ACD Explanation Occurrence Jt1R JUR Suspended 08/07/2012 09/30/2013 D53 Non-Payment of Iowa Fine IA IA Suspended 10/10/2012 09/30/2013 D53 Non-Payment of Iowa Fine IA IA Suspended 03/14/2013 09/30/2013 D53 Non-Payment of Iowa Fine IA IA Name:Opel,Chad Michael DL/ID: 047AA4079 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: -r1 . ...L7>—..i C ) GAMS., C )..< _ SMIZ6NN dE IPE B'ly •C) C' ,'4O?• �'/a,' 12/10/2014 r•-- r45--.1 IOWA �''� -,t -0 6 4:314?t407 71 I,r1 iiiii- r i • Office of Driver Services Oai R owaDpartmetofTrnsportation Name: Opel,Chad Michael DL/ID:047AA4079