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Home My WebLink About14-263 Authorization Number / ---11 I _ 1 (Office Use Only) ®A' VIIIitini 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 Firs dle Last 1. Name (REQUIRED) 1� � iC211Ae6J- 2. Mailing Address (REQUIRED) 9(5 ,�1 )/1.h I .(,`( tr �' 3. Contact Information (REQUIRED) Email: �� }1 F-4 �^�/� Ai/ Cell Phone: j/9 �7 5 la 4. Prior experience in transportation of passengers: /(, cri-p) (la/ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where WhetimiltwoDI 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? Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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 names) 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-rgqueii r (OVER FOR REQUIRED SIGNATURE AND NOTARY) .- 09/2014 r I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number / --7�2. ) . I understand that if I falsely answer any questions in this application, that this applicationay 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 .11 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 / ('� YOU ARE NOT VALID TO 9"IVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authors-ed 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 5 c_ ,:1 C. ,rc, 0 .Q . On this 9 -}--h day of ,iP,_ewLia.9-,__ �1 �l �(�. lilati Notary Public in an for the State of Iowa conriZonir 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). ‘'designee 4, 9 .2„ ,, Signatu o of hief 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. 21ei lik:/ 4-7.4.1i.--1--"" /' ;VI Signature of 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 Clerk/TAXIDRNBADGEAPPL92014amended.DOC 09/2014 Page l of 2 ',-,-, 05mINARTEil 1 Di /71111111--s, I -.. .o,, VANW IOWA Ot cjav Sir � i ��}( [ I� Office of Driver Services PO Box 92041 Des Moines.IA 50306-9204 Phone:515-244-9124 1800-532-1121 I F�515-23 1837 37 Certified Abstract of Driving Record Inquiry Date: 12/3/2014 DL/ID #: 261DD7008 (IA) Customer#: 2455902 ID Status: None Name: Crane, Sean Thomas Class: B : VAL Address: 902 SPRING RIDGE DR Audit#: 8026681 CDL DL Status: Status: VAL Issue Date: 04/30/2014 Expiration 04/02/2022 CDL Cert Non-Excepted City/State: IOWA CITY, IA Status: Intrastate 522465892 Date: Endorsements: NONE CDL Med None Status: Restriction None Mailing Address: 902 SPRING RIDGE DR Restrictions: NONE Supplement: Date of Birth: 4/2/1982 Mailing City/State: IOWA CITY,IA Sex: M 52 CDL Downgrades End ACD Issuing RJR Type Effective IA Downgrade 05/04/2014 05/21/2014 History Information Convictions County JElR Citation Date Conviction Date ACD Explanation Wasington IA ............. 04/28/2008 07/07/2008; 820 Driving While Suspended, Denied, Cancelled, Revoked Name:Crane, Sean Thomas DL/ID: 261DD7008 r s, Iowa rtment of ion, do Pursuant to Iowa Code 1.1 of theook,records heldrof Office of by the Office ofDriverServices, thatDthis ais a true and accurateocopy of hereby certify that I am the custodian 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 documeAt, at Ankeny, Iowa this date: 11 -; -- C")- : I te.— ( r- -4(--) ) .:D , lite,11C1f.: y, 12/3/2014,: --^-, 14: IOWA ' ',0 , '"FD, 0, T,: Office of Driver Services y'h1 f ill Iowa Department of Transportation 12/3/2014 12/03/2014 10:49 FAX 4 DCI IOWA 4002 • .irASTATE OF IOWA - e l\ i, riminal History Record Check • 44-fAll Request Form ''.,,,. ?.J V��1r , OA • DCI Account Number:4383-FC (if applicable) To; Iowa Division or Criminal Investigation From: Marco's Taxi Support Operations Bureau,lel Floor 116 SCevene Dr. 215 C.71h Street Des Moine!,Iowa 50319 Iowa City,Ie'52290 _ (515)125-6066 —. (515)725-6080 Fax • Phone: 919)337-8________ I___...._-- Fax: (319)351-8294 I am reuastin an Iowa Criminal t iisto Record Check on:Mulls_ — Middle Name(naommaltletn Last ae nutodatory) First Name(mandet_uq) _ Date of Birth(mandatory) Gender(mandatary) Social Securi Number(recammeoded _�fo2 __ alp ❑>I�emalQ - _ t Waiver information;Without a signed waiver from the subject of the request,a complete criminal history record may not be reloasahle,per Code of Iowa,Chapter 692.2.For comm to criminal history record Information,es allowed by law,always obtain a waiver s)gneture from the subject of threq e u -----T- est. -, _ Waiver Releases l hereby give minimise fix the above requesting official to conduct an Iowa criminal history record chock with the Division of Criminal lY inrosdgadon(DCI). Any criminal histo data concerning me Is maintained by the DC!may be released as allowed by law. • Waiver Signature:. .. low Criminal istory Record Check Its mac►a, only) As of /2/ ! / , a search of the provided name and date of birth revealed: �. cD, . --; �t a 1 No Iowa Criminal History Record found with DCI 0 Iowa Criminal History Record attached,DCI#_ c.E:.._ _ DCI initials i ,/ DCI-77(08/25/10) n 1 I T. n 1 'AtA 1A. ACAtA M. (AGI