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Home My WebLink About14-258 Authorization Number 1"T — o?S7-2j (Office Use Only) APPLICATION FOR TAXI/ MOTORIZED PEDICAB VEHICLE DRIVER r A CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday–Friday.) n Street 240-1 826 Failure to complete the "required"information will result in denial of the application XFir t jJ Ie ast . ame ( IRED) «r C3L Pj&a 2. Mailing Address (REQUIRED) % / 15/5 tel_' F // JJ4 3. Contact Information (REQUIRED) Email: �ace44<,q�37� y/L Cellll Phone: 7 7 3-�19-'��'s'3 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _ Type of offense Where MVP yaILr nu , 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /1/ 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 4/« 8. Has your driver's 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-name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED .— DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE aH1EF 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 certify_that I have issued to me by the Iowa Department of Transportation a valid Cha 4j -5 741- 2Z 7 I . I understand that if I falsely answer any questions in th application may be denied. I understand that if I falsely answer any of the questions in this application, tha be denied. I agree that in making this application, I consent to allow agents or employees of the City of I their discretion, to examine any and all records and documents relating to this application, and I further agree th , is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signe of a Notary Public) � b Signature of Applicant /�/cr 1 r c,C ate if7-/- /y lJ 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ';-,<<u , j C rl-e ii, v cti„� . On this l day of D c i ti �..�_'-e c 1c,/(-/ A WENDYIt mays Notary Public in aric)for the Ute c2,19-_-\__ f lowa 71MY -1 / o tAnimesion Exp ****************** **************************************************************************************************** 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). /. ii ii / - /-/�/ Sign ure of P. icl 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. 32fr1 / • � - e?/ - /Y at e of City Clerk or designee Date 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/TAXIDRIVBADGEAPPL92014amended.DOC 09/2014 Nov. 21. 2014 12:07PMn1 ' Div of Criminal Investigation No. 4728 P. 1/1 I.� •. LV. LV 1� L. Lull,' V11r VICIK VII,' VI IV17Q VI orIeQ. )'+IU r. L • �9':'nFlrl%�. STATE 01 IDLY IOWA r,„ ,� '= �`��` Cirimi nlul rHistory R Ii'• . 'i I,r.l: 01 Request FormlA t ,, .,: DCI Account Number: cf'—)� (I sf ppliceble) To; Iowa Division of Criminal Investigation prom: City of Iowa City Support Operations Bureau,1"Floor City Cleric's Office 216 E.716 Street 410 E.Washington Street Des Moines,Towa 50319 (515)725-6066 rows City, TA 52240 (515)725'6080 Fax _ Phone: 319356-5041 Fax; 319-356-5499 I ant requesting an Iowa Criminal History Reoot-d Check on: Last Name(monkery) • First Name(mandatory) 1Vliddle Name(recommended) a , Date of Birth(meudelory) Gender(mandatory) _ Social Security Number(recommended) 3 - 42 S — 2 2 r);h ale UFemale 3 LCs--3--4/1 16 92 WaiverIiforntadionr Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 6911 For complete criminal history record information,as allowed by law,always obtain a waiver sJl nature from the subject of the re r nest. Waiver Release:I hereby give permission for the above requesting official to conduct an Iowa criminal Ills tory record check with the Division of Criminal Investigation(DCI). Any crlminel history data concerning me that Is maintained by the DCI may be released as allowed by law. WaiverSignature: -.:;.1.f....:.I. - - ._ • Iowa Criminal Ifisto .10ieek Result , =2— �BLI116Bo; —rn As of ' /1/____42L/____ a search of the provided name and date of birth revealed: ''. z' • No Iowa.Criminal History Record found with DCI • 0 Iowa Criminal History Record attached, DCI# .; iv DCI initials Received Timelov.10.111014 2:24PM No. 4664 . , . .f , .,_ „,,,,,,.4,„ r I I WA DOT SMARTER I SIMPLER ( CUSTOMER DRIVE www.Iowadot Ov Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124(800-532-1121 I Fax:515-239-1837 www.iowedot.gov Certified Abstract of Driving Record Inquiry Date: 11/20/2014 DL/ID#: 457AF2271(IA) Customer#: 5739037 Name: Coleman,Barry Joseph Class: D ID Status: VAL Address: 1445 WESTVIEW DR Audit#: 5639315 DL Status: VAL Issue Date: 11/18/2011 CDL Status: None City/State: CORALVILLE,IA 522411031 Expiration Date: 03/28/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1445 WESTVIEW DR Restrictions: NONE Restriction None Date of Birth: 3/28/1972 Supplement: Mailing City/State: CORALVILLE,IA 522411031 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 07/24/2012 08/14/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA 11/14/2013 .12/18/2013 Improper Registration Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 03/05/2011 621527 :IA Name:Coleman,Barry Joseph DL/ID:457AF2271 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: p�vtlU6.. 4 i�i •,,•• •• •is 11/20/2014 .4:- IOWA I.% ice: :tr0 ar ica&vievat . r....a ::D. O. T..i....- 0 sen:(0/r'•••�•�rtrt n--. - Office of Driver Services --• .� t��q��:`��r Iowa Department of Transportation - y a� < W Name:Coleman,Barry Joseph DL/ID:457AF2271 C' �M Y7: I .1 = way