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Home My WebLink About14-017 ` R Authorization Number / 1-7 1 1 1 (Office Use Only) III 011 Ala. WI 111 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 First Mice Las 3rcywk_c_u_rel,1 r—Name \ ' 2. Mailing Address . 171./ EE L 3nra,1 .cL L j 3. Telephone: Home Other.( )\ v / J a 5 - ) r} (L 4. Prior experience in transportation of passengers: 1110 C\S‘+'G ( C_invr, &I----y) e)\ p hS n(` �� o\/ PP 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? \A'S Type of offense Where When O r 1��. O Q Cp(*( � � ` - 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?1 )1—,`��,` "` Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) NJ 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) clerkttaxidrivbadg 03/2013 r I hereby cert tat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number !J, I' (c )D 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) Applicant of Signature Date – .10 t 9 9 ✓!� **#*####****##*****#*###****#*#***********#**************#*****#*###*#**##**#*********#**********##*#****###*****#****#****#******************#* STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by U (h��yud5 A . r- (4 &;CLQ On this ,y-t'L-t day of —5–cavt u(Q ( o.� c"°ur WENDY S.MAYER No ary 'ublic in anJ or the State of l.(a Cornrmasron rvumoer 72i42o • My Commission Expires ew tler 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). 14.51 Signature Police or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNT;:_AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. 7i( 'Signare 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 clerkJtaxidrivbadgeapp2010.doc 03/2013 t1 h atDepartment of Transportation J. Office of Driver Services (Toll Free)800-532-1121 4 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/16/2014 DL/ID #: 713YY6801 (IA) Customer it: 390483 Name: Bromwich,Thomas Arthur Jr Class: D ID Status: EXP Address: 2374 EE AVE Audit#: 7705226 DL Status: VAL Issue Date: 01/16/2014 CDL Status: None City/State: LADORA, IA 522517537 Expiration Date: 09/23/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2374 EE AVE Restrictions: NONE Restriction None Date of Birth: 9/23/1965 Supplement: Mailing City/State: LADORA, IA 522517537 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 06/24/2007 10/04/2007 A20 Operating While Intoxicated Iowa IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 06/24/2007 .A98 OWI Test Failure '.IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 10/18/2007 10/17/2008 A98 OWI Test Failure IA IA Name: Bromwich,Thomas Arthur Jr DL/ID: 713YY6801 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: uteicu'4 o . 071 14, 1/16/2014 sr*: IOWA :t,, i=e4ren Mt O. T.mo ,I'1j.utifi t% Iowa of Driver Department paartme teof Services Transportation Name: Bromwich,Thomas Arthur Jr DL/ID: 713YY6801 Jan. 21. 2014 , 4:05PM Div of Criminal Investigation No. 7218 P. 3 Uan, 10. 2019 11 :7Jm City 1.1erK - Llly 01 loWWa 1,114 Pio. ciao P. L • • ' e,,.i,:A�d` 8TATJII OF 10WA : ` , ' Q �{ Criminal History Record Check RequestHorn 3 :f, 0 n0) `113.20.:4,30 ;sirj rAin ACI Account Number; LID c)(I r f (ifappltcable) To; Iowa Division of Criminal Investigation From; City of Iowa City Support Operations Bureau,1"r Floor City Clerk's Office 215 E.7th Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa city, IA 52240 (515)725.6080 Fax Phone; 319-356-5041 . 319356-5497 I.am requesting an Iowa Criminal IlistoiyBeecord Check on: . Last Name (mandatory) First Name(mandatory) Middle Name{recommended) Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) _ 9/2 31 65 EiMale ❑Female O 2g -60 - 50 f`7 Waiver In forinatlon:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Coda of Iowa,Chapter 692.2.Fpr pomoletQ criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:1 hereby givo permission for rho abort requesting offiolal to conduct an fovea criminal history record check with the Division of Criminal Investigation(DCI). Any uiminal history data con coming n . hv t is meinl.lned by lheDCl may berclwscd as allowed by law. Waiver Signature: . • • 5 Mom ..___ -- { (/ Iowa CriminalHistoryRecord Check ResultS (Dame only) a search of the • u As of I-ZI-14 provided name and date of birth revealed; rc-:; c ---1 rflO _n co•--.1 — D No Iowa Criminal History Record found with DCI• c5-,-3; 4,0"n �t _ O o 12 Iowa Criminal History Record attached,DCI# &LEO(4 ±rr'.'. Na )::' DCI initials b c . Received Time7Jan. 14, 0.2014 11 : 52AM No, OBO7 Jan. 21. 2014 4:05PM Div of Criminal Investigation No. 7218 P. 4 1 IOWA CRIMINAL HISTORY DCI 00608674 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2014/01/21 DCI:00606674 NAME: BROMWICH,THOMAS ARTHUR BROMWI OH,THOMAS ARTHUR JR BROMWICH,THOMAS ARTHUR, JR BROMWICH,TOM DOB SEX RAC HGT W(3T EYE HAIR SRN POB 19650923 M W 509 195 BLU BLN MA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19991030 AGENCY; IA04B0000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 033701301 COURT DISPOSITION AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 033701301 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 7D 20000413 FINE $1500 20000413 CREDIT W/TIME SERVED 20000413 02 ARRESTED 20020926 AGENCY; 140480000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA708-2A-2A DOMESTIC ASSAULT TRK#: 024302501 COURT DISPOSITION AGENCY; IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2(5) ASSAULT COURT CASE ID: 06481 SMAC063245 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 024302501 SENTENCE DISP EFF DAT SUSPENDED JAIL 7D 20021203 JAIL 7D 20021203 FINE $50 20021203 PROBATION 365D 20021203 03 ARRESTED 20070624 AGENCY: IA0400000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE Jan. 21. 2014 4: 05PM Div of Criminal Investigation No. 7218 P. 5 v DCI 00608674 PAGE 2 OF 2 TRK#: 079334701 COURT DISPOSITION AGENCY: IA04807.5J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE COURT CASE ID: 06481 OWCR009416 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 079334701 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT JAIL 7D 20071004 PINE $1875 20071004 COURT COSTS 20071004 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. 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 W