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Home My WebLink About14-185 Authorization Number / — 1 (Office Use Only) ®gra 41:17.41a;A APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name e` lrst ve1drd e Las ath 2. Mailing Address -7 / 63/I SI 7717::, -;1. s z q 3. Telephone: Home Other: 3/9 " '-Y 122. 4. Prior experience in transportation of passengers: o? y� r c �.,{ 6.4(.14, 60b? CU, a;,i 2.)A4,1- 4—'7E4 )A4,r4•'/1^ ('//01....J 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? JJd 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? 'Lb Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /JO Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Tv Type of offense Where When /Va d,,ia_ -Le/v.4 /cy,1,1.' i4.5" S4,002/1r.'vn. 'To 0/03//1, q /10 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) clerknaxidrivbadg 03/2014 I hereby cert y that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number -7( i 0 . 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 record and documents relating to this application, and I further agree that, if a license is granted, to comply at all times ' h all • o •rn iisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date f/-Li/i l 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 a S E.. ct...& et.g . On this ',t Q tjt, day of /L13LI 30th. ( Q 5t)A �tslAt WENDY S MAYER Notary Public in d for the State of I Na . Cl,n,��.,..a,en K,.,�.b�. 923420 • • My Comm on Expires low '7-{7- ************************************************************************************************************************************************ 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). 7 , Signature of Polices' of or designee Date YOU ARE ► • ' ,LID Q DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK' • 0 IC)/1 uth. ized taxi driver names are placed on the city website at icgov.org. d I 1,. Sign.tu r- 41,01. 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 clerl taxidrivbadgeapp2o14.doc 03/2014 SMARTER I SIMPLER I CUSTOMER DRIVEl " VWUtN.[OVIIaIC3tC(3V, ' Office 01 DriverServices PO Box 9204 I Des Moines,IA.50346-9264 Phone:515-244-9124 1800-532-1121 8.Pax:515-239-1837 veiny.iowadot.giav Certified Abstract of Driving Record Inquiry Date: 8/26/2014 DL/ID#: 769YY6550(IA) Customer it: 3953016 Name: Daniels,Chad Everet Class: D ID Status: None Address 301 COLLEGE ST APT 4 Audit#: 8151223 DL Status: OTH Issue Date: 06/10/2014 CDL Status: None City/State: TIFFIN,IA 523409377 Expiration 01/02/2017 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 110 GOLFVIEW CT Restrictions: NONE Restriction None Date of Birth: 1/2/1983 Supplement: Mailing City/State: NORTH LIBERTY,IA Sex: N 523179715 History Information Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident DateCase Number JUR 10/15/2012 ._e. ._.._......._. ____m�.... ....__..__ i707650 __.._ _ .._._.._._ . ,IA.. Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended i10/03/2012 12/09/2012 :D51 Non Payment of Child Support IA .,.,..., IA Suspended 04/24/2014 06/02/2014 LD51 Non Payment of Child Support IA IA Suspended :08/14/2014 08/20/2014 D51 Non-Payment of Child Support IA IA Name: Daniels,Chad Everet DL/ID:769YY6550 Pursuant to Iowa Cade§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: pvti ✓p, '' • 8/26/2014o *V3a: IOWA 4oo° u J ,, " tu �a$ Office of Driver Services ru,ar Iowa Department of Transportation • oe4rAug._22. 201491.2: 11PM;ab EDiv_2f Criminal Investigation (FAX)319336271No, 8170 P. 1,1/002 lal■ ■ • STATE OF IOWA esti ,;~' i. Criminal History Record Check ('i.. � ' n! /14,riY-• Request Form .. ,' • DCI Account Number; 9967•F • (Ifapplle►blo) • Tel Iowa Division el Criminal Investigation From Yellow Cab of Iowa City • Support Operations Bureau,I"Floor P,O.Box 428 21S B.7th Street ba Moines,Iowa 60319 Iowa City,IA. 52244 (815)720.6066 (515)'725.6680 Fax (319)338-9717 Phone; • Ra : (319)3394302 I am requesting an Iowa Criminal History Record Cheek on; • —/Last rName ausgealoy) First Name(mendrloryl'• Middle Name(recommended) • Date of Birth(mandatory) Gender(mandatory) •Social-Se'eurity Number(recommended) ( L a , )9d3 liliMale DFemale 4tf-1 ,- /.3,53 Waiver Information:Without a signed waiver from the subject of the request,a complete Criminal binary record may not be releasable,per Code of Iowa,Chapter 692.2.For comnletg criminal history record infprmgtion,as allowed by law,always obtain a waiver signature from the subject of the request. • Waiver Release;I baby give ponnlwion for neo a.• b .;L) In:010010 ndum . lo • .. mina htttorymrnrd cheek wllb ala Mahlon of Criminal • Invnnpedon(DCD, Myodmin:ihinorydi:eoneani ;• o !. 1 by the Del be NI- .iasellowedbylaw. Waiver Signature: • )ova CrItiltlinai_History Record check R- • Its =lute only) As of CC I> "Ali , a search of the provided name and date of birth revealed; ❑ No Iowa Criminal History Record found with DCT :' `2 Iowa Criminal History accord attached,ACI# �Q �S`� V Iv• DCI initials DCI 77 (08/2S/10) Received Time Aug, 18. 2014 12:22AM No. 7567 .._ . Aug. 22. 2014 12: 11PM Div of Criminal Investigation No. 8170 P. 2 IOWA CRIMINAL HISTORY DCI 00635759 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2014/08/22 DCI:00635759 NAME: DANIELS,CHAD EVERITT DOB SEX RAC HGT WGT EYE HAIR SRN POB 19830102 M W .600 155 no BRO MED IA • ADDITIONAL IDENTIFIERS CCN RECORD *** 01 ARRESTED 20001207 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 FOSS OF A SCHED I CONT SUBS TRK#: 054380601 ARST DISE.: ADULT ARRAIGNMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE - SR COURT CASE ID: 06521 SRCR057B95 CHARGE CLASS: NON CONVICTION TRK#: 054380601 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010516 PROBATION 1Y 20010516 . . DISCHARGED FROM 20020124 DEFERRED JUDGEMENT 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 DCI. IN THE ABSENCE OF 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