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Home My WebLink About14-063 Authorization Number 7 — 1; - 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 irst� Middle Last 1. Name U� �.,� / Middle /4., 2. Mailing Address (0?d( 7 Ce.._4(�Ct2�J(F GJ ��2 ��/ / 3. Telephone: Home .3/?- ..�� 7O O Othe( ) 5/Y" 5C6 — 6 3 G / 4. Prior experience in transportation of passengers: -(S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /f6' Type of offense Where When 6. Have you beegrl convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? A-}(' Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When ,as 3 - 5 - 2c5/) 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /v d- 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) ,/)v 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 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number J -I C C- / P)Li . 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) ,gyp Signature of Applicant v Ue._ IAa Date ---" '��' ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by i— k1e t t-- E. C-,ce. S-. . On this 1 1--)--t- Ci day of 11-/L a f L& JD) 4 . t o cc) S GL(ca�,,,Q_ MENI WENDY S MAYER = Notary Public in anor the State ofpwa o ICoM •r s • - My Commisn Pile 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). W1 3 ///U /v Signatur ofCPolice Chief or designee gg 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. 1. ��c.-e---01-2 -4--) _.") 3 /i /Si nat e of CityClerk or designee to 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 clerMaxidrivbadgeapp2010.doc 03/2013 wvew.iowadat.gov SMARTER 1 SIMPLER i CUSTOPJiER DRIVEN ,, . ----rS_,.-..,.,r. - Office of Driver Services PO Box 9204 j Des Moines,IA 50306-9204 Phone:515-244-91241300-532-11211 Fax:515-239-1337 YANW.iarrado4.gov Certified Abstract of Driving Record Inquiry Date: 3/13/2014 DL/ID #: 243CC1584 (IA) Customer#: 1747283 Name: Gates, Robert Eugene Sr Class: B ID Status: None Address: 6706 WATERVIEW DR SW Audit#: 6667097 DL Status: VAL Issue Date: 02/05/2013 CDL Status: VAL City/State: CEDAR RAPIDS,IA Expiration Date: 06/09/2018 CDL Cert Status: Non-Excepted Intrastate 524047715 Endorsements: NONE CDL Med Status: None Mailing Address: 6706 WATERVIEW DR SW Restrictions: Corrective Lenses Restriction None Date of Birth: 6/9/1948 Supplement: Mailing City/State: CEDAR RAPIDS,IA Sex: M 524047715 History Information Convictions Citation Date Conviction Date ACD Explanation County ]UR 03/03/2013 03/05/2013 1114 Fall to Obey Traffic Sign/Signal Linn IA Name: Gates, Robert Eugene Sr DL/ID: 243CC1584 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: 0100.•'• -..•44, 3/13/2014 1 .: IOWA • i*o odirehriv eetertzt4 ; •• • T.::j ,,r �y�61VEP Sett/ Office of Driver Department Services Iowaf Transportation Name: Gates, Robert Eugene Sr DL/ID: 243CC1584 Mar. 10. 2014 3:30PM Div of Criminal Investigation No. 4767 P. 2/2 2014-v.)-uo c.):u1 a1KruRT SKUIILh ShKV 5198621094 » 515 res 608u P 3/3 • fYc% � 140 ri .Y fJ ' 4*q ,, . STATE OF IOWA , �•' °.d `, !11 ,'°`"" A--4 1 ICriminal History Record Check1 y.. 1'4 '; • . ferItitioi;r Request Form At',y` ., DCI Account Number: c l-1L —F- (if applicable To: Iowa Division of Criminal Investigation Frotnt Atr Paw— („1ce, Support OperatlonsBursa a,1"Floor Z15 E.rk Street atoll Ar-tiuvrenlq.asi%4A Dec Moines,Iowa 50319 � 1 � (S15)725-6066 CQ0O.t— f M aLl (515)725-6080 Bar Phone; 3l9 365 (56,--C€ Sign al ecoo . to9q 1 em requesting an Iowa Criminal Histo Reoord Check on: Last Name ow.sasloryg First Name(mendolmy) Middle Name(eccommendcd (Cr)/9-) r5 atter. i c 'e Date of Hirth (maMseory) Condor(mandatory) Social Security recommended) 61- fl XMole 1i1Femaie //g/c„5.6 e 9‘27 waiver lnformationt Without a signed waiver Preto 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 lhrarmallon,areltawed by law,always obtain a waiverslfnature from the subject of the request' • Waiver Release;I hereby give perm balm forme Abaco aqua Ling official to Mani ac Ion ethnical history mud eheck with fisc twines of Criminal investigation(AC). My criminal hiaory den cmarelegma that Is mainlined by aACIm be Pleased to allowed by law. WaiverSlgnature: Aar..' Iowa Criminal His o Record Check Results (4ct rc miry) As of 3-10-19 a search of the provided name and date of birth reverted: aNo Iowa Criminal Riskily Record found with DC1 t CJ A- ^r ryC 0 Iowa Criminal History Record attached,DCI# p a ' ti r t ACI initials dJ'1 w --s I:, 't -c, ..1 on —1-1. f7 bCI.77(08/25/10) iJ r., > Received Time Mar. 7. 2014 1 :52PM No. 1323