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Home My WebLink About14-128 Authorization Number_ s r 1 (Office Use Only) Ens 4 .rnl, *Z 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 Fir MiddleLast 1. Name dn4-, / „�ple.s 2. Mailing Address (7t7 (4 /7y Gbrio/ //vJ (� — :�+ C(10� _> 3. Telephone: Home ��—�?3 —/ ?f7Other: 4. Prior experience in transportation of passengers: p2o:.a 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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? -14' Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /2.0 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 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) /IP 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) derk/taxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �� 4"/- . 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 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. STATE OF IOWA COUNTY OF JOHNSON ) Su cribed and sworn to before me by )11C (Y ►'L . On this )7344.- - day of ,` sT KELLIE K.TUTTLE Notary Public in and for the State of Iowa �' �, unnnlaal� 4un,Lcr221010 rl My o ssio Expires A I C 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). Dom} 4d- 0-7/74/ Signature of Police 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. • p / Signature CityClerk or designee at 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 clerWtaxidrivbadgeapp2014.doc 03/2014 Iowa Department of Transportation 413 Office of Drofer Servoces (Tdl Free)900-532-1121 PO Hoot 92(}4,Des Manes,L 50306-9204 515-244-9124 FAX:5155-239.183? Certified Abstract of Driving Record Inquiry Date: 6/5/2014 DL/ID#: 813AK6294 (IA) Customer#: 6223809 Name: Mcferrin, David Class: D ID Status: None Charles Address: 1102 HOLLYWOOD Audit#: 8136294 DL Status: VAL BLVD UNIT 12 Issue Date: 06/05/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/17/2019 CDL Cert Status: None 522407002 Endorsements: 3 CDL Med Status: None Mailing Address: 1102 HOLLYWOOD Restrictions: NONE Restriction None BLVD UNIT 12 Supplement: Date of Birth: 1/17/1978 Mailing IOWA CITY, IA Sex: M City/State: 522407002 History Information CLEAR DRIVING RECORD Name: Mcferrin, David Charles DL/ID:813AK6294 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: 6/5/2014 j . ail v.D. O. T ..,..:: 440;7 icattertexii ��77 Office of Driver Services Iowa Department of Transporation Name: Mcferrin, David Charles DL/ID: 813AK6294 „) Jun. 9. 2014 4:29PM Div of Criminal Investigation No. 1243 P. 7/7 Jun. 5. 2014 3: 33PM City Clerk - City of Iowa City No. 4/0u P. i 3(iljcr ' ;d� „ : STATJE OF IOWA 14 r, Criminal HistoryRee@rd Check Request ra , r % � u )ms ' ' A ' 7. • DCIAccountNumber: / e°07 "I • (Ie applicable) to Iowa Division of CrinminalInvestigation From: City of Iowa City . Support Operations$atea;I'tFloor City Clerk's Office • • 215 7'h street 410 Z.Washington Street , Dos Moines,Iowa 50319 (515)925-6066 Iowa City, LA 52.140 (515)725-6000 Fax Phone: 319.356-S041 Fax: 319-356-5497 ' I am requesting an Iowa QiminalHistoryRecord Check on • Last Name(mandato13) IC+IYstName(mandator) , Middle Naha(receinmcnded) 07cFerr%vt LS cA,4e r • Date of Birth(mandsto,y) • Gender(mandatory) Social Security Number (recommended) OViV7gigili�aIe Female• ay� — S"3 -9387 Waiver Information:Without a 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 bylaw,always obtain a waiver signature Prom the subject of the request, • Waiver Release:r botchy give permission fordo alum(agouties ootclel to conduct an Iowa criminal history record check with theDlatdon of Criminal InYealtgatIon(DCI). Any criminal history data conocndng me Iliac Ismaintained by ihmDClmay Doreamed as allowed by law. • Waiver Signature; ----” • . 1 owe Criminef Melon Record Cheek i' estill�. ... (6;�iusee3Dty) . As of (oi l Ig , a search of the provided name and date of birth revealed: ., {. • V .12 No Iowa Criminal History Record found with DCI = i '' -; c: 0 Iowa Criminal History Record attached,DCI# Received Time Jun. 5. 2014 3:31PONo. 1691-1-CY