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Home My WebLink About14-065 l Authorization Number I ' t9J 1 (Office Use Only) APPLICATION FOR TAXI 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 rstl Last v n 1. Name I o i 2. Mailing Address r)(3? ?""`T Vi ✓ % 3. Telephone: Home JJ if Other: 3n-331 -59D,. 4. Prior experience in transportation of passengers: Dfll)'I~f J Ttb qli s' JO rr5 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? %"— Type of offense Where When 3-Jini Com/ as�� amt .37hn n g 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? ,_4b Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? j\Q Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? es) 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 names) 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) clerWtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i +L S�C'23�N(.)5 . 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 th provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) 7. Signature of Applicant l' "'""- Date 34 1ibli STATE OF IOWA COUNTY OF JOHNSON ) Subscribgd and sworn to before me by nark,, kQ;-kLL . On this 1 `t _ day of \Nota Public in and for the Sta f Iowa 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). o / 3iy//y 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. 9i n re ofi Clerk or desi nee 9 tY 9 Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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 clerkWtaxidrivbadgeapp2010.doc 03/2013 iMar:'11: 20141:11PM COiv of Criminal Investigation, NNo. 1618 P. 7/13 Flip' • • . STATE OF IOWA .0,' v t.,„i,, �rA, , Criminal History I2eeord Check � IJ •- % /`Cin ( V. , ,'-',1 ...rfi Request Form ,rr;_,r.J, ' tiiiimiso • DCI AccountNumber: q[7D; sir (If applicable) To: Iowa Division of Criminal Investigation From: City ofIowa City Support Operations Bureau,la Moor City Clerk's Office 215E.in'Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Towa City, IA 52240 (515)725-6080 lrax • Phone: 319.356-5041 piun 319-356-5491 X am requesting an Iowa Criminal History Record Check on: ' Last Name andafoy) First Name(mends tory) Middle Name(recommended) Dia $%drao K . Data of Birth(mandaory) Gentler(mandatory) - Social( Security Number(recommended) 6 J O J n a ale QFemale f - Is- r 1c6.3 Waiver Information;Without a signed waiver from thesubject of the request,a complete criminal history record may not he releasable, per Code of Iowa,Chapter 692.2.For complete criminal history record Information,as allowed by Jaw,always obtain a waiver signature front the subject of the request. Waiver Release:I hereby give permission forte above requesting official lo conduct en Iowa criminal history record check with the Division ofCrimnaal Investigation(DCI). Any criminal history dela ooaceml os lis maintain by the DCI may be reeleasseed as allowed by law. Waiver Signature;. W .AAA jut L r • Iowa Criminal History Record Check Results • (mime only) .As of 3. 1 I-I Lc ,a search of the provided name and date of birth revealed: r_ - '-'r Tic. z :1> [l No Iowa Criminal History Record found with DCI vi ; — ; _..i o ” �0 . ' ,n'1i Iowa Criminal Ilistoty Record attached,DCI# J1�331 =I : at ' 's._ r- N :i . DCI initials j Received Time—Mar, 10. /014— 9:54AM—No. 4654 DCX-77Ina 2s/1. l Mar.,11. 2014 1 : 12PM Div of Criminal Investigation No. 1618 P. 8/13 IOWA CRIMINAL HISTORY DC1 00700337 FELONY CONVICTION PAGE 1 OF 6 DATE PRINTED- 2014/03/11 DCI:00700337 NAME: IRVIN,ANDREN KEITH IRVIN,ARDX . DOB SEX RAC HGT WGT EYE HAIR SIM POB 19880920 M W 510 185 BLU ELN PAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L ARM TAT R ARM TAT R HND TAT R SHLD TAT R WRS TAT R WRST TAT RF ARM TAT UL ARM TAT UR ARM CCH RECORD *** 01 ARRESTED 20030615 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708.2(1)' ASSAULT INTENT OF INJURY TRK#: 029257201 COURT DISPOSITION AGENCY: COUNT NO- 01 IA STATUTE IA708.2 (1) ASSAULT INTENT OF INJURY - 1978 COURT CASE ID: 06521 JVJV002935 CHARGE CLASS: STATUS UNKNOWN . TRK#: 029257201 SENTENCE ADJUDICATED DELINQUENT PROBATION TRAINING SCHOOL 02 ARRESTED 20050613 AGENCY: XA042015C ELDORA ITS POR BOYS CHARGE NO- 01 IA STATUTE IA708.2(2) ASSAULT CAUSING INJURY TRK#: Y06282001 INMATE #: 27317 COURT DISPOSITION AGENCY: COUNT NO- 01 IA STATUTE IA708.2(2) ASSAULT CAUSING BODILY INJURY-1970 CHARGE CLASS: STATUS UNkNOWN TRIO: Y062B2801 SENTENCE DISP EFF DAT ADJUDICATED UNTIL 18YR9 OF AGE 20050613 • Mar. 11. 2014 1 : 12PM Div of Criminal Investigation No. 1618 P. 9/13 DCI 00700337 PAGE 2 OF 6 DELINQUENT • CUSTODY AGENCY: IA077025G FAMILY CHILD SVC BUR A 20051123 PAROLED PLACED 03 ARRESTED 20060518 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESSION OF SCHEDULE I/CONTROLLED SUBSTANCE TRK#: 053351501 ARST DISP: ADULT ARRAIGNMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 TA STATUTE IA124.401 (5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE XD: SRCR0077457 CHARGE CLASS; NON CONVICTION TRK#: 053351501 SENTENCE DEFERRED JUDGEMENT DISCHARGED FROM 20070829 DEFERRED JUDGEMENT 04 ARRESTED 20061005 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA321J.2 OWI 1ST OFFENSE TRK#: 101997702 ARST DISP: ADULT ARRAIGNMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 1ST OFF COURT CASE ID: 06521 OWCR077456 . CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101997701 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DXSP EFF DAT JAIL 2D 20070124 FINE $1250 20070124 05 ARRESTED 20060315 • AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J.2(B) OPER VEH WE INT (OWI) / 2ND OFF TRK#: 1A003ND01 Mar. 11. 2014 1 : 12PM Div of Criminal Investigation No. 1618 P. 10/13 DCI 00700337 PAGE 3 OF 6 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFF COURT CASE ID: 06521 OWCROB2685 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A003ND01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT SUSPENDED JAIL 530 20000610 JAIL 600 20080618 FINE $1875 20080618 PROBATION 1Y 20080618 TIME SERVED 53D 20090602 IMPOSED 53D 20090602 REVOKED 20090602 06 ARRESTED 20080910 A AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA716.5 CRIMINAL MISCHIEF 3RD DEGREE - 1978 TRK#: 1A0053D01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA716.5 CRIMINAL MISCHIEF 3RD DEGREE - 1978 COURT CASE ID: 06521 AGCROO4402 CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: 1A0053D01 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED JAIL 30D 20090306 JAIL 30D 20090306 SUSPENDED FINE $625 20090306 FINE $625 20090206 PROBATION 1Y 20090306 SUPERVISED PROBATION BY DCS, TO RUN CC W/OWI 07 ARRESTED 20090319 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 05 IA STATUTE IA713.5 BURGLARY 2ND DEGREE - 1983 TRK#: 1A006E105 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 05 IA STATUTE IA713.5 Mar: 11. 2014 1 : 12PM Div of Criminal Investigation No. 1618 P. 11/13 DCI 00700337 PAGE 4 OF 6 BURGLARY 2ND DEGREE - 1983 COURT CASE Yb: 06521 FECR086545 CHARGE CLASS; FELONY CONVICTION TRK#: 1A006E105 RESTITUTION SENTENCE DXSP EPP DAT SUSPENDED FINE $1000 20090814 FXNE $1000 20090814 PRISON 107 20090814 08 ARRESTED 20090319 A AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE 6 COUNTS TRIO: 1A006E202 CHARGE NO- 03 IA STATUTE IA713,68(1) ATTEMPTED BURGLARY 3RD DEGREE TRK#: 1A006E203 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 FECR086894 CHARGE CLASS: FELONY CONVICTION TRK#: 1A006E201 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED FINE $750 20090814 FINE $750 20090814 PRISON 5Y 20090814 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE XA713 .6A(1) BURGLARY 3RD DEGREE COURT CASE ID; 06521 FECR086894 CHARGE CLASS: FELONY CONVICTION TRK#: 1A006E203 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED FINE $750 20090814 FINE $750 20090814 PRXSON 5Y 20090814 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 07 IA STATUTE IA713.6B(1) ATTEMPTED BURGLARY 3RD DEGREE Mar: 11. 2014 1 : 12PM Div of Criminal Investigation No. 1618 P. 12/13 DCI 00700337 PAGE 5 OF 6 COURT CASE ID: 06521 FECR086894 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A006E205 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED FINE $625 200908/4 FINE $625 20090814 PRISON 2Y 20090814 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 22 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 FECR086894 CHARGE CLASS: FELONY CONVICTION TRK$: 1A006E209 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED FINE $750 20090814 FINE $750 20090814 PRISON 5Y 20090814 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 11 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID; 06521 FECR086894 CHARGE CLASS: FELONY CONVICTION TRK#: 1A006E216 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED FINE $750 20090814 FINE $750 20090814 PRISON 5Y 20090814 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 18 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 FECR086894 • CHARGE CLASS: FELONY CONVICTION TRK#: 1A006E221 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED FINE $750 20090814 FINE $750 20090814 PRISON 5Y 20090814 COURT DISPOSITION AGENCY; Mar.. 11. 2014 1 : 12PM Div of Criminal Investigation No. 1618 P. 13/13 DCI 00700337 PAGE 6 OF' 6 IA052015J JOHNSON CO DIST COURT COUNT NO- 20 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 FECR086894 CHARGE CLASS: FELONY CONVICTION TRK#: 1A006E223 RESTITUTION • SENTENCE DISP EFF DAT SUSPENDED FINE $750 20090814 FINE $750 20090814 PRISON 5Y 20090814 09 ARRESTED 20120719 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA713 ,6A(1) BURGLARY 3RD DEGREE TRK#: 1A00ERE01 COURT DISPOSITION AGENCY: XA0S2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 FECR098775 CHARGE CLASS: FELONY CONVICTION TRK#: 1A00ERE01 RESTITUTION SENTENCE DISP EFF DAT FINE $750 20121009 PRISON 5Y 20121009 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 ii „ _ . , . clap, - . DOT , . SMARTER I SIMPLER 1 CUSTOMER DRIVEN www iowadotgov Office of Driver Services PO Box 92041 Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 1 Fax:515-239-1837 www.iowadaf.gov Certified Abstract of Driving Record Inquiry Date: 2/26/2014 DL/ID It: 803YY0215 (IA) Customer rf: 5064985 Name: Irvin,Andrew Keith Class: C ID Status: EXP Address: 738 BAY RIDGE DR Audit ri: 7685602 DL Status: VAL Issue Date: 01/09/2014 CDL Status: None City/State: IOWA CITY,IA 522465897 Expiration 09/20/2016 CDL Cert Status: None Date: Endorsements: NONE CDL Med Status: None Mailing Address: 738 BAY RIDGE DR Restrictions: NONE Restriction None Date of Birth: 9/20/1988 Supplement: Mailing City/State: IOWA CITY,IA 522465897 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 05/14/2006 01/24/2007_ A20 Operating While Intoxicated Johnson 'IA 03/15/2008 06/17/2008 ,A20 Operating While Intoxicated Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 05/14/2006 Al2 :,OWI Test Refusal __ IA 03/15/2008 €A98 fOWl Test Failure IA ',, Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked ]05/25/2006 Al2 iOWI Test Refusal IA IA _ Revoked 103/26/2008 105/24/200703/25/2009 ,A98 !OWI Test Failure IA IA Name: Irvin,Andrew Keith DL/ID:803YY0215 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: rsciiiiin iki .ti : Cr,, i8: IOWA 4‘ Isl.D. 0.T.,:J� 2/26/2014 I Office of Driver Services Iowa Department of Transportation Name: Irvin,Andrew Keith DL/ID:803YY0215