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Home My WebLink About14-091 r w Authorization Number / Y r lise Only) I _ i (Office 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 First Diddle Last 1. Name Er; k cwt_ Jorgtm �.e!'i 2. Mailing Address '4,q LieCIwtn15 Ar Ari 6 Iowa Gil ; [A 5,2W J 3. Telephone: Home (3(o) 54i- 2 4t 7 Other: 4. Prior experience in transportation of passengers: PArcb's T 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? IV t) 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? 1V Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? I 5 Type of offenseII ,ff Where When A ck 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? I S Type of offense Where r When i�Abi a� V+� �4 3r TbLNA C4 1 t,4 0/0.2/0 — ((/?39/l 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) clerk/taxidrivbadg 03/2014 r , I hereby cert that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 7( KXc.72 cl 2 . 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) a17- Signature of Applicant ' ------- Date OM ifrn 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 EA,: , f , jp,/ye,,,,_ . On this , )-t day of '"`F'S ' t 9°ILI . , a.° 1.*. WENDY S MAYER Notary Public ublic in a for the State of I&Wa Aiow,xi. C�/flilInsS.lull l4urllbwr 129'i26�• My Commission Expires I '7--J 1 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). q/ly (f Signature • r•. . - Chief or designee ate 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. 11(� -)t --- --1-4--/ `/V�/? Signat re 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 clerkllaxidrivbadgeapp2014.doc 03/2014 1 It arlIN Iowa Department of Transportation Office of Driver Services (toll Free)800332-1121 11. IV PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/17/2013 DL/ID#: 713XX2292 (IA) Customer#: 3717523 Name: Jorgensen, Erik Steven Class: D ID Status: VAL Address: 1506 SPRUCE ST Audit#: 5653250 DL Status: VAL _ Issue Date: 11/29/2011 CDL Status: None City/State: IOWA CITY,IA 522406030 Expiration Date: 04/30/2014 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1506 SPRUCE ST Restrictions: Corrective Lenses, SR Restriction None Required Supplement: Date of Birth: 4/30/1986 Mailing City/State: IOWA CITY,IA 522406030 Sex: NI History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 02/04/2009 ;03/04/2009 592 Speed 'Johnson ,IA 04/18/2010 ,04/28/2010 S92 SpeedJohnson }IA 07/25/2010 08/04/2010 08/04/201.0IM14 (Fail toObey Traffic Sign/Signal IJohnson IA _ 01/01/2011 0_1/14/2011 iM14 Fail to Obey Traffic Sign/SignalJohnson SIA 02/13/2011 102/24/2011 S92 Speed �� !Johnson !IA 04/07/2011 105/26/2011 IM14 Fail to Obey Traffic Sign/Signal «µ� Johnson IA i Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 02/13/2009 1494178 ;IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended ;07/02/2011 11/28/2011 ,W01 ;Habitual Violator iIA IIA { Name:Jorgensen, Erik Steven DL/ID: 713XX2292 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: yw Yy\ 0,4. *0C[fp%"h 0.... ......ors, iz/17/2013 fS! IA111lA ee od,Apr. 4. 2014,8 4: 35PM Div of Criminal Investigation 4 DC1 ,ioiNo. 6770 P.-4I/1. , I A n STATE OF IOWA, „...,15:,....; 1."''"';< '-•i CriminalHistory Record Check -•:: ,.. ` , ° , Request Form •'4 • DCI Account Numbor: Ii3B3-Pt �I1� Mt t— 0lsre lmhle) Ta: Iowa Division of Criminal Investigation lr}omi Mell(Cr 5 I �t1 Support Operatlone Bureau,l"Floor 215 E.7°Street 5 &vcv.s Or. tp k DnMolnn,Iowa 50319 /� A, ' —. ._—(915y7zfaG056—. . ... _ —. 0(aa—U.A, I /1 --5a44C-- (515)7256090 ras Phone: ,(3M) 35v' VP1. . Put.- (31q) 351-8 .' 1 Ian requesting an Iowa Criminal History Record Check on: - .. 'Last Name(nw4uy) Flat Name(mnbto,y) -Middle Plume ow.ammo rd) JdrytiSFM &ri4. - Sf8VPe1 Date of Birth(minium) • Gender(mummy) Social Security Number(,voommeadan 0+730/f9gi miMale ❑Female tfS—o8—i?le Waiver Information:Without a piped waiver from the subject of the request,•complete*Modal history record may not • be releasable,per Coda of Iowa,Chapter 692,2,For comDIelo criminal history record Information,as allowed by law,always ()Dain a waiver slanature frost the select of the request. Waiver Release:!Way giro ponebdon fordo stye regoains official w condom m tow criminal history record check wlO,n Division of Criminal Inrmipnon(DCI). Any mhnln.l binaydda tence�ine�mqu &h met,uined by the DCI mray W Mead w, d by la • —{I'al9arbYgrrrrMlf a —t�+'�l T _ Zowacriminal History Record Check Results (Da me only) mot kAtk 1 Lk ,a search of the provided name and date of blah revealed: ... r o No Iowa Criminal History Record found with DCI u,•i; 1 t:::ri . :c—, N 7C.7 t;):I r J i!i t 0 Iowa Criminal History Record attached,DCI# '-- DCI initials Att ` — DC07(08/25/10) Received Time Apr, I, 2014 4: 15PM Igo. 3809 + r i anew crir - City of, A C'� April 2, 2015 Mr. Dustin Adam Hills 543 N. Oliphant West Branch, IA 52358 In re: Notice of Hearing on Revocation of Authorization to Operate a Taxicab Dear Mr. Hills: Pursuant to City Code Section 5-1-5, I am notifying you that a hearing has been scheduled for 8:00 a.m. on Monday,April 6, 2015, in the Helling Conference Room at City Hall,410 E. Washington St., Iowa City, Iowa. The hearing before the City Manager, or designee, is to determine whether the authorization to operate a taxicab in Iowa City should be revoked for the following violation of state law: In March 2015, you were at Target in Coralville, Iowa taking photos and/or videotaping girls while they were changing in the dressing rooms. One victim was 14 years old. You admitted to the Coralville Police Department videotaping two other girls. This violates Section 709.21 of the Code of Iowa(invasion of privacy) and 18 USC §2252C (possession of child pornography). As a result, I am recommending revocation of the authorization that allows you to operate a taxicab in Iowa City. Sincerely, Marian K. Karr City Clerk 410 FAST WASHINGTON STREET• IOWA CITY IOWA 52240-1826•(319)356-5000•FAX(319)356-5009