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Home My WebLink About14-217 Authorization Number 1 4 - 1 7 i (Office Use Only) AMOZOIAIr 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-S497 FAX First / Middle Last 1. Name (REQUIRED) ;.'�✓)0 rP(�✓ 4.10,r-64 l � Ib', '�-c' J 2. Mailing Address (REQUIRED) tco5 //ci '► 5 O�,cr (//r/(//r/ S 722,(/(/7 3. Contact Information (REQUIRED) Email:0,S,/JWc nkiyMDAvr2.ii-/.<n'`-'Cell Phone: (.//5' 4. Prior experience in transportation of passengers: 2., �/!1 ►*5 err�i�� `rep/ 'm) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /1/t7 Type of offense Where When 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? \/ . `7 Type of offense Where When ,j kite__ 30 o6.711/4_,',�; �/S, � �8 tiN 'i (e-117 l IR-127/1-0/ / 1 Aes/.ste 11neipit (v/// 7/1Z2/Z2I-17 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? >G Type of offense Where When /110#1- f yrt f o _15—0 )'Lp19%.l ("m n r j ( f/O/T 9 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 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 certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Z-Z_ A S . 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 //2 Date (7—Cr() 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 ) Sscribep and/sworn tQ before me by it- //►pct) D iy1GZS . On this � day of ,IA( KELLIE K. NotaryTUTTLEPublic in and for the State of Iowa o . , Co-I-MSS+on MU!rLcr 23161Q ? t My C41 issi,n Expires ********************************* •• *. *** *******************!.***********k********************************************************* 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). 740„ Signa re of Por 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. —6,1/L) /' - 029" /L Signet 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 ClerklrN(IDRIVBADGEAPPL92014amended.DOC 09/2014 Sep. 29. 2014 11 :23AM Div of Criminal Investigation No. 0788 P. 3/7 Se2. 22. 2014 3:06PM City Clerk — City of Iowa City No. MY P. L ., ` nA (aI ICriminal History 8eco il CGaeck tH� Y �� vRequest FOW11101 -0),.-;; ;---(.41,1, etaI�alSi f DCT AccountNtnnber; V b02 ' (itayelin le) To: Iowa Division of Criminal Iuvestfgatlon Froml City of Iowa City Support Operations Bureau,1`I Floor City Clerk's Office 21SE.714 Street 410 E.Washington Shoot Des Moines,Iowa 50319 (515)129.6066 Iowa-City, IA 52240 (S15)125.6080 Fax Phone: 319-356-5041 • • . Fax; 319-356-5491 rain requesting_an Iowa Criminal llistol1 Record Check on: Last Namen (mandatory) First Name(mandatory) Middle Name(recommended) /11131fr]otc A�lalr/.yj 4a✓2914 Date of Birth(mandatory) Genddeerr(maudetory) Social Security Number(recommended) • 3/ C)) lq< LdM'a1e UFenlale _ ?JI Is.fl- 9fl L, Waiverrnfonna/on:Without a signed waiver from thesubject of the request,a complete criminal hisiory record may not ba releasable,per Code Wawa,Chapter 692,2.For complete criminal history record Information,as allowed by law,always obtain.a waiver signature from the subject of the request. • • b➢ainer.Retease;I hereby give permission for(ha above requesting official to conduct an Iowa criminal history recordcheck with the Division of Criminal Investigation(DCI), Any et ndnal history dale concemting me null is maintained by the DC1 may 6o released as allosvedbylerg > Waiver,SYgfaafafe: U Aowa Criminal ;.!issttory ,Record CheckRe u1ts (DCIUsoonly) As of q I k t •a search of the provided name and date of birth revealed; : `•-. • • No Iowa Criminal History Record found with DCI EJ Iowa Criminal History Record attached,gDCI# DCI initials AC---- • nncA;und TimPs:SPr 99 n•9014 3t09PM No. 0930 DOT SMARTER I SIMPLER I CUSTOMER DRIVEN .IOWBCIC) .gov Office of Driver Services PO Box 92041 Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www_iowadot.gov Certified Abstract of Driving Record Inquiry Date: 9/27/2014 DL/ID#: 433ZZ8765 (IA) Customer#: 2169524 Name: Thomas, Andrew Aaron Class: D ID Status: None Address: 2743 TRIPLE CROWN LN Audit#: 7669216 DL Status: VAL APT 2 Issue Date: 01/04/2014 CDL Status: None City/State: IOWA CITY,IA 522407244 Expiration Date: 03/30/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2743 TRIPLE CROWN LN Restrictions: NONE Restriction None APT 2 Date of Birth: 3/30/1987 Supplement: Mailing City/State: IOWA CITY,IA 522407244 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County ]UR 11/03/2011_ !12/1_3/2011 .M14 Fail to Obey Traffic Sign/Signal Johnson w RA07/30/2013 ;08/28/2013Improper Registration Johnson IIA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR _. Suspended 11/20/2013 12/03/2013 D53 {Non-Payment of Iowa Fine ilA 'IA Name:Thomas,Andrew Aaron DL/ID: 433ZZ8765 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: .c-43..• . .74'i 9/27/2014 4: IOWA S% od : n, r /,' I1N ,g �BN % - Office of D river Services IowaDepartment ry Transportation Name:Thomas, Andrew Aaron DL/ID:433ZZ8765