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HomeMy WebLinkAbout18-061 IDENTIFICATION NO. /a L I 1 r 1 (Office Use Only) v11, 16e APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday) CITY OF IOWA CITY 4 I 0 East Washington Street Failure to complete the "required"information will result in denial of the application Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Last First Middle 1. Name(REQUIRED) Kx � &V1-•t(trI 2. Address (REQUIRED) L4 :3S 03-4i I, �{,-t 3. Contact Information(REQUIRED) Email: 1L1e-I30r, 5 1 C-) 0.-kLIAI I' Gell Phone: 3/ `i 9 34,,,,., 7, (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) ) 6 1 15- ,-)--t): . b. Taxicab Business Name (REQUIRED) '\/ -t LJ, --0 5. Prior experience in transportation of passengers: ,_ 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? y - ® Type of offense\tOls Wk-re When I Y ° ( , Qat, • bt' ©w,j / 9, n ./'I r-� o 1 1 q L;) vpa-,6, (q, 16 ,-y,7 o v6 -I °t'9 % ,2 o >�.a 44 ix /� 1 • a- Ph' � of -- e..C,/ I�e, ) k-e Q X05 What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended lead G 'Ity Ote 7. Have you been arrested/charged with any traffic offenses in the last five years? Type of offense Where yy ____ c -< N r`"" r- -r, r-r1 What happened to the charge?(Circle one) p2 c.? 0 Convicted Dismissed Deferred Suspended Plead Gui jr Ott. 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1,1_,6- Type L vType of offense Where Wien 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) L (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 , APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI)REPORT AND STvTFCEIk7FIED" DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLIC21IEF4 Report(form aEVI You must apply for an individual Department of Criminal Investigation � 9v�,c-- upon ret t). ^i7-3 73.1 W 1;2 cri -37 I he. by certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number H ` 7 Z 11(, I lit issued on S/I J 11expiring on `j//5/..2-k, I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provis'ons of Title 5, C apter , of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant '` Date 6/ ' / I U ***********************************************************.***t*********************************it*-x******r********************* ***►rtxfrr**s«* STATE OF IOWA ) COUNTY OF JOHNSON ) Sub§sribed and sworn to before me by )4,21.-t - I ce_r4i-e-r- on this 2-4 day of . ) L.t -'Q Zott'� . etYI�NDY 8.MAIIER ilJe CannwMion Nirnb�r 72W28 No ary Publi ii and for the State Iowa _ **********************************************irk**InV******************************************************************************************** I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City(Title 5, Chapter 2, City Code). Expiration date of Dr' ' 'cense (-II 1 5—1 =)-- . ,,o(,_,,----";--------7-------- 7 6,-- z /— )g Signatur- if Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. ` , L. e '-(2 ( , ) , .. - 2i - I ***** .,,," 6 Sign re of City Clerk or iesignee Date ************************************************** Office Use Only Approved application DCI report State certified driving record Website update ClerkfiAXIDRIVBADGEAPPL92018amended.DOC 04/2018 . . olOWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN UVWW'IOVI/Bdot gOV Dam I ldi,W 1caetan Swims PO Box 9204 I Des Moines.IA 503069204 Phone 515.2449124 I Fax 515-279-1637 Certified Abstract of Driving Record Inquiry Date: 6/11/2018 DL/ID#: 841ZZ8616(IA) Customer#: 2808014 Name: Barber, Keri Class: C ID Status: EXP Kathleen Address: 433 S VAN BUREN Audit#: 1821082 DL Status: VA ST APT 1 ..- Issue Date: 05/18/2017 CDL Status: -5 Nonce .11 City/State: IOWA CITY, IA Expiration Date: 09/15/2022 CDL Cert Statu •ons �� 522401937 Endorsements: NONE CDL Med Status',- NN_one r�y Mailing Address: 433 S VAN BUREN Restrictions: Corrective Lenses Restriction 1�pe 12, i ! II'�4 O ST APT 1 Supplement: - Date of Birth: 09/15/1969 C W Mailing IOWA CITY, IA Sex: F City/State: 522401937 y. CJti J History Information Convictions Citation Date Conviction Date ACD Explanation County JUR I04/12/2008 05/06/2008 B51 No Driver's License [Linn IA Name: Barber, Keri Kathleen DL/ID: 841ZZ8616 Pursuant to Iowa Code§321.10, I, Darcy Doty, Director of Driver&Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver&Identification 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: (E ) OF 74i6/11/2018 ole9 0, Driver&Identification Services FfO� 4t DOG' Iowa Department of Transporation FILED 2010 JUN 21 PH 3: 51 CITY CLERK IOWA CITY, IOWA, 00 N N ti J C C N Gl I YN G/ I- 0 N CO E 10 Z °cr..," 1 ;‘, Lvi.o . 3: 37riv inv of Criminal Investi ation 1• Cab g No. 4018 P. 1/5 TAX)319 338�,vu r,ukr2/002 • • -- ? , ' ,ninaZ History Record fli,,,XW.3.':i' l a i ' _" ` fJtir Request Form � �ti ,-...... ..,it...,---sL- DCI Account?*lumber: 9967-F To: Xowa Division of Criminal Inves}lgac:pp (if applicable) from: Yellow Cab of Xpwa C1 Support Operations Bureau, .1"kloor 215 E. 7th Street P.O.Box 428 • Des Moines, Iowa 50379 (513)725-6066 Iowa City, 52244 (515)725-6080 Fax ' (3I9)338-9777 , • Phone: a ' Rax: (319)339-7342 . I am ro•uostir,; an Iowa Crimina-1 Histo Reoord Choak oro; Last name (mandatory) ''First Name(mandato ) Middle Name(r000mrnvnded ate- ' i� (424,fr. Jute of$lrth (lnand:o'ry) ., Lender mondatory) / s (P Cl, L. „_.. . o >$I'Sectarx Numberr rtcomad ) aleemale '• Ifr6-7.7 ,2 8-6 l giver �j{form¢i�pn; thouf a 9tgned vaiver from the subJect o€the regpest,a com 1 to c be releasable,per Code of Iowa, Chapter 692,2.,dor�omnlete criminal hisfor obtain a valvar P � rfminai history record may not si:nature from thesub•ect'ofthe re, y record ln>ortnation,a$allowed by Al ,v,, always •''aiuer Release;r h Uopy8've permission feru0'Rbove requestingofficial to conduu an(owe criminal istory record check with the Division of Criminal 1nv (DCI). Any Criminal Maurydata Conccmiig me that is maintained b the ACI rn• be released asallowed • by lEw. Waiver Signature: ', _'Z"� k-' 0 l • Iowa Criminal rnstor Record Check Results ' AS 0 �� o(DCI use only) a search of thes provided name and date of birth revealed. ~ =a 0 No Iowa Crimtria] History kec,ord found with ICI t-` M • ti-----keyw Qya CriminalHistory Record attached, DCI# a?. ' dri DCI?riitials . • CJl • }V DCL-77 (08/25110) 6.1 Received Time Jun. H. 2018 11 : 00AM' No. 0312 Jun. 12. 2018 3: 35PM Div of Criminal Investigation No. 4078 P. 2/5 IOWA CRIMINAL HISTORY DCI 00395847 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED- DCI:00395847 2018/06/12 NAME: BARBER,KERI KATHLEEN DOB SEX RAC HOT WGT EYE HAIR SKN POE 19690915 F W 505 185 BRO ELK MBR IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC L ANKL TAT R ANKL CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19891001 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L36882501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VER WH INT OWI CHARGE CLASS: NON CONVICTION TRK#: L36882501 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19900130 PROBATION lY 19900130 DISCHARGED FROM 19901210 DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 19900114 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVINGI WHILE REVOKED TRK#: L36882601 COURT DISPOSITION o _ r m AGENCY: 1A052015J JOHNSON CO DIST COURT CD �l COUNT NO- 01 TA STATUTE: IA321J-21 D--1 Z DRIVE WHILE REVOKED CI.< N r- CHARGE CLASS: MISDEMEANOR CONVICTION =1C1 `"n TRK#: L36882601 =�— -b nC SENTENCE DISP EFF DAT .7 CW JAIL 2D 19900405 c,l1 03 ARRESTED/TAKEN INTO CUSTODY 19960810 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-1 THEFT 4TH TRK#: 019242801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-1 THEFT 4TH Jun. 12. 2018 3:35PM Div of Criminal Investigation No. 4078 P. 3/5 DCI 00395847 PAGE 2 OF 4 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 019242801 SENTENCE DISP EFF DAT JAIL 140 19951015 FINE $250 19970124 PROBATION 1Y 19970124 SUSPENDED 30D 19970124 REVOKED 19981015 04 ARRESTED/TAKEN INTO CUSTODY 19990600 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 TA STATUTE IA321J-2(2E) OWI 2ND OFFENSE TRK#: 040825601 COURT DISPOSITION AGENCY: IA057015J LYNN CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 040825601 SENTENCE DISP EFF DAT PLEAD GUILTY 19981026 JAIL 200 19981026 FINE $1000 19981026 SUSPENDED FINE $500 19981026 COURT COSTS 19981026 05 ARRESTED/TAKEN INTO CUSTODY 20050719 AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA321J.2 OWI 2ND TRK#: 101595501 na CHARGE NO- 02 IA STATUTE IA726.6 �-? CHILD ENDANGERMENT CD rco TRK#: 101595502 COURT DISPOSITION n-� N "' AGENCY: IA052015J JOHNSON CO DIST COURT =7"7< in COUNT NO- 01 IA STATUTE: IA321J.2 (B) '{ 3 OPER VEH WH INT (OWI) / 2ND OFFZE S COURT CASE ID: 06521 OWCR073154 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101595501 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DIS? EFF DAT JAIL 7D 20051020 FINE $1500 20051020 Jun. 12. 2018 3: 35PM Div of Criminal investigation No. 4078 P. 4/5 DCI 00395647 PAGE 3 OF 4 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA726.6 (7) ENDANGERMENT/NO INJURY COURT CASE ID: 06521 0WCR073154 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101595502 SENTENCE DISP EFF DAT JAIL 7D 20051020 FINE $500 20051020 06 ARRESTED/TAKEN INTO CUSTODY 20051120 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA321J.21 DRIVING WHILE REVOKED TRK#: 503334401 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA321A.32 OPERATING VEH/W LICENSE SUSPENDED (FINANCIAL) - 1978 COURT CASE ID: 06571 SRCR064399 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 503334401 SENTENCE DISP EFF DAT TIME SERVED 20060111 FINE $250 20060111 JAIL 2D 20060217 07 ARRESTED/TAKEN INTO CUSTODY 20120103 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PAESCRxPTION DRUG TRK#: 5AOOFME01as C7 c� COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT C',"4. N COUNT NO- 02 IA STATUTE: IA123.46 --C) i " CONSUMPTION / INTOXICATION - 1978 COURT CASE ID: 06571 SRCR096096 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#. 5A0OFME02 SENTENCE DISP EFF DAT FINE $65 20120530 08 ARRESTED/TAKEN INTO CUSTODY 20120411 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA725.1 PROSTITUTION - 1978 TRK#: 5AOOGII01 COURT DISPOSITION J1rk 12. 2018 3: 36PM Div of Criminal Investigation No. 4078 P. 5/5 DCI 00395847 PAGE 4 OF 4 AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA725.1 PROSTITUTION - 1978 COURT CASE ID: 06571 AGCR09B220 CHARGE CLASS: MISDEMEANOR CONVICTION TRIC#: 5AOOGI I01 SENTENCE DISI? EFF DAT FINE $625 20120530 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OP IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCI. XN 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 e.a CO O CO S'3 -71 Tr- x r" '17 P1 a 0 W ti7 ..J