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Home My WebLink About14-085 Authorization Number - 1 (Office Use Only) WI"NIX II •IR WI 1W CITY OF IOWA CITY APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (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 Middle Last 1. Name • awe- ,c,r f l\1(,r• 40tn.,g-(-,Q„ 2. Mailing Address 1 \03 l-A-oi&y&,occ 1�1 v c' (oc.Jc, CAk-y 3. Telephone: Home 3(4 ck3 S a'0, Other: 4. Prior experience in transportation of passengers: ev ofJ C�vL y, r ,r�,� -t-cvx, y r 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 1--) 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? Type of offense Where When S��%��d t o� K rte, �✓ S /11-1/ 13 WC - oO Q 513ti f,,A--fCA /6( / t 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? )\,1 o 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 CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report(form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) derldtaxidrivbadg 03/2014 f I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 6 .(1 "/,y g C.. . 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 GJDate (713// I 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 Z a c n 6A, ut l -3-i-1,Na4% bt• . On this �� day of 41 WENDY S.MAYER D)-^-426-1_, IkA�� °--.:��r Commission Number 729428 Notary Public in for the State of I�wa� ow -13— La ************************************************************************************************************************************************ 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). / ili '. —� Signat of Policy •hief 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. _l' ezc,� . 7 � ��— .� _ 7 / gna 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 clerkttaxidrivbadgeapp2014.doc 03/2014 03/Feb. 28. 2014912:05PM Div of Criminal Investigation • nex Iola°. 4094 P #$fo • • STATE OF IOWA , •t' .z.: , Criminal History Record Check m Request Form :`. DCI Aocounl Number 9313-Pc- (If AppIkable) T0: Iowa DWiefunorCriminal investigation Fromt (M4raas'TAXI Support Operations Bureau,l"floor 5}rNe,.s �✓ 21511,1bStreet 725es,Cawo 60319 O41w at" 1, A g.yf 0 (5I 715 (515) 4066 iLf (515)7156000 Fax' Phone: :L310 338' a-9Lf. Fax:_ . (3l 9) 3514;1`f • -lam requesting an Iowa Criminal History Record int�Check ame on om' tee) - Middle Name(nmmeannw� Last Name(naedelory) L Date of Birth(aarmcory) Gender(oaadena4 Social Security Number amair..64 fro 08//1/83 6fMate ❑Female USa l PIZa,g — Waiver information:Without a aired waiver from the subject or the cagiest,a complete criminal M i my record may nor be releasable,per Coded Iowa,Chapter 6922 For colaele%&mind Story record Information,u allowed by law,always obhin a waWeY rlgnature Prom the sublect or the reauat. &ham � Mayo aeato NI maml ��maeniwlmolCrmlMl tm (DCI).Myhillory dux wea mwabloeDCI!!my elevadbylaw Waiver Signature-. — _ .---- Iowa Criminal Ilistorv_Record Check Results mtliaec"ty) As of a--02_0-t/ ,a search of the provided name and date of birth revealed; �-•t t xm 0 No Iowa Criminal History Record found with DCI • ' r•i 74 9S( 'cy -� i„-', 14/ Iowa Criminal History Record attached,DCI# �_ r t;, o _ 7-•,.t N DCI Initials r ra _ DC•1-77(08125110) • • Received Time Feb. 25. 2014 11 :56AM No. 0340 , . Feb. 28. 2014 12:05PM Div of Criminal Investigation No. 4094 P. 3/4 IOWA CRIMINAL HISTORY DCX 00907524 • COURT DISPOSITION PENDING PAGE 1 OP 1 CONVICTION STATUS UNKNOWN DATE PRINTED- 2014/02/26 DCI:00907524 NAME; JOHNSTON,ZACHARY WILLIAM DOB SEX RAC HGT WGT EYE HAIR SRN 'POB 19830819 M W 510 140 BLU XXX FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: CCH RECORD 41* 01 ARREBTED 20130916 AGENCY: 140520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE /A124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRIO: 1AO0HD901 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 EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION • • • ••1 i 14 e V ...,.- .., Do 0 4, , , `Avt A.fts vv oct SMARTER I SIMPLER I CUSTOMER ®RNNEId Office of Driver Services PO Box 9204I Des Moines,FA 50305-9204 Phone:515-244-91241800-532-1121iFax:515-239-1837 Wwtiv.iowadot:gov Certified Abstract of Driving Record Inquiry Date: 4/2/2014 DL/ID#: 769YY8452(IA) Customer It: 3605007 Name: Johnston,Zachary William Class: D ID Status: EXP Address: 1103 HOLLYWOOD BLVD Audit it: 7297019 DL Status: VAL Issue Date: 08/30/2013 CDL Status: None City/State: IOWA CITY,IA 522407047 Expiration Date: 08/19/2018 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1103 HOLLYWOOD BLVD Restrictions: Corrective Lenses Restriction None Date of Birth: 8/19/1983 Supplement: Mailing City/State: IOWA CITY,IA 522407047 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 02/27/2011 104/08/2011 1114 'Fall to Obey Traffic Sign/Signal Johnson 1IA _l 05/14/2013 � ;06/24/2013 ....,.,._,__._... S92 Speed -___. ..., Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/06/2012 "" ._.._...._.......�.�........... __. 1668178 .,... .............�..m..,... _..._IA Name:Johnston, Zachary William DL/ID: 769YY8452 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: �tECIEp W A .• ••�7 4 4/2/2014 (cfj ilin eetestor44t4f0%•'^"• Office of Driver Services nt,cin Iowa Department of Transportation Name:Johnston, Zachary William DL/ID: 769YY8452