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Home My WebLink About18-088CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319) 3S6-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. cF2 — (Office Use Only) FILED APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department rer b0 2018 AUG ' rjrade between 8 a.m. to 3 p.m., Monday —Friday) " V11 � cltY.VINA First Middle 3. Contact Information (REQUIRED) Email Phone: (All written communication seri is email) 4a. Driver's License expiration date b. Taxicab Business Name (REQUI 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? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead G /� Other 7. Have you been arrested/ charged with any traffic offenses in the last five years. 1 \ () Tvoe of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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) (SECOND PAGE FOR 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI)�iEj RjAt DD STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATI M7QR PQLICE CHIEF REVIEW You must apply for an individual Department of Criminal Invesjjfti9n jRe�rtMrrP qilable upon request). CITY CLERK 10%NA CIT Y, 10 I hereby cert' tha I have i ued to me by the Iowa Departm t of Transportation valid Drivers license number (4��q t 6 iZ issued on I 16 expiring on�� I understand that ifI falsely answer any questions in this application, that this appl cati n may be denied. I ag ee at 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 prov' ' s of Title 5, C ew er 2, 1 f the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date �� 1 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to befom me bv_ r M.on this Z� day of E � i�28 My Can ww `7 IToTary Publi and for the Sta of to 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 VA of Police Chief or - 7,q- Z Z d-Z8-� R 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. Sign ture of City ClerkoYdesignee Office Use Only Approved application DCI report State certified driving record Website update -mak -/ k Date am✓rMDRNenoceAPPL9201� WC 04/2018 Aug.20. 1018 1:48PM Div of Criminal Investigation No.9865 P. 1/8 0811412018 09:34 Y611OW Cab 0:4310 338 2708 P.0021002 FILED STATE OF;l$'IpVV8 PN 2: 01 ? Criminal H#story Recpgrolilgr ►e kq . .� ° Request ,Form f, DCI Account Number: 9967-P '°. (Inapplicable) To: Iowa Divis(on or Crlminalanvestlgallon Support Operstlopp Bureau, ]" Floor From: _fellow Cab of Iowa City 215 E. 7" Street P•O. $ox 428 Dos Molnes;lows 50319 (SiS) 725-6066 IOWA -C -11-Y, lA, 52244 (515) 725.6080 Fax (319) 338-9777 Phone: Fax: (319'}'9'7302 , J 1� �I"� � �•]F�e1e �Betniale � �- �S� Waiver %njorrisafion; Without a signed waiver from the subject of the request, a comploto grlminal history record rpay no be releasable per Code 4f Iowa, Chapter 692.2, For corim Iete criminal history -record Information, allowed by law, always obtain a waiver al nature Koro the svb'ect of the request WalYer itekaSe; I hereby give pemnissiofi4or the abbvo milostting o(lielsl (o wndoc(an Iowa eilminil history record check with V e Division of Criminal InresV®etlon (DCt). My crtminsl history dam edn In a IAat Is malnuinea by the DCI mry be rolemed ns agowed'by Lw, Waiver Signature: ii Iowa Criminal History Record Check Results Q� (DGl use only) As of U ' 2 0" a search of the provided name and date of birth rovoalod: ❑ No Iowa Criminal history Record found with. DCI r 5i l� Iowa Criminal Itis{pry Record attached, DCI # i� a n ACI initials Sys o •�� o� t)CI-77 (68/25110) - r Aug -20. 2018 1:48PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00660170 MISDRMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - DCI :00660170 2018/08/20 NAME: JACKBON,TONY CHARLES JACKSON,TONY CHARLES 14ARVELL DOB SEK RAC HGT WGT EYE HAIR SKN POB 19781124 M B 510 275 BRO BLK DRK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y ART L ARM TAT L ARM TAT LF ARM TAT R ARM TAT RF ARM TAT UR ARM CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20011223 AGENCY: 1AUS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 owl TRK#: 100431301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / SER MISD / 1ST OFF - COURT CASE ID: 06521 OWCRO60864 - CHARGE CLASS; MISDEMEANOR CONVICTION TRK#! 100431301 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 2D 20020131 FINE $1000 20020131 02 ARRESTED/TAKEN INTO CUSTODY 20020331 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OPERATING WHILE INTOXICATED TRK#: 100512101 CHARGE NO- 02 IA STATUTE IA321J-21 DRIVING WHILE REVOKED TRK#: 100512102 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER YEN WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCRO61729 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#! 100512101 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 7D 20030903 No -9865 P. 2/8 m l co O C-) G 'J � Aug.20. 2018 1:48PM Div of Criminal Investigation No -9865 P. 3/8 DCI 00660110 PAGE 2 OF 3 FINE $1000 20030903 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE; IA321J.21 DRIVING WHILE LICENSE DENIED OR REVOKED COURT CASE ID: 06521 OWCRO61729 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100512102 SENTENCE DISP EFF DAT FINE $250 20030912 03 ARRESTED/TAKEN INTO CUSTODY 20050313 AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA708.2A.2B DOMESTIC ABUSE -- ASSAULT CAUSING INJURY TRK#: 101464801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY COURT CASE ID: 06521 SRCR071782 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101464801 SENTENCE DISP EFF DAT JAIL 2D 20050819 FINE $250 20050819 04 ARRESTED/TAKEN INTO CUSTODY 20090612 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J.2(C) OPER VEH WH INT (OWI) / 3RD OFFENSE TRK#: IA0071501 COURT DISPOSITION AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCRO87430 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA0071501 DRUNK DRIVING SCHOOL LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 48H 20091001 DL REVOKED FOR 6 YRS. FINE $1250 20091001 F Aug.20. 2018 1:48PM Div of Criminal Investigation 05 ARRESTED/TAKEN INTO CUSTODY 20140816 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J.21 DRIVING WHILE LICENSE DENIED OR REVOKED TRX#: IA00JMC01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO^ 01 IA STATUTE: IA321.174A OPERATION OF MOTOR VEHICLE WITH EXPIRED LICENSE COURT CASE ID: 06521 SRCRIO6149 CHARGE CLASS: SCHEDULED TRAFFIC VIOLATION TRK#: 1A00JMC01 SENTENCE FINE $50 DCI 00660170 PAGE 3 OF 3 DISP EFF DAT 20141117 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 OT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.9865 P. 4/8 N d i W 0-! N co x J N �' O �4 U ADOT SMARTER I SIMPLER I CUSTOMER DRIVEN m%raimadot.gov Driver B ldsmifioation Sarviess Iia Box 9204 I Des IAclnes IA 63305 S204 Phone 515-737-91741Fax 7A'-739-1KA7 Certified Abstract of Driving Record Inquiry Date: 8/14/2018 DL/ID #: 846AA1812(IA) Customer #: 5076631 Name: Jackson, Tony Class: C ID Status: EXP Charles Marvell Address: 1109 12TH AVE Audit #: 9463388 DL Status: VAL Issue Date: 10/01/2015 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 11/24/2022 CDL Cert Status: None 522411305 Endorsements: NONE CDL Med Status: None Mailing Address: 1109 12TH AVE Restrictions: NONE Restriction None Supplement: Date of Birth: 11/24/1978 Mailing CORALVILLE, IA Sex: M City/State: 522411305 History Information Convictions Citation Date Conviction Data ACD Explanation iCountv JUR 06/12/2009 10/01/2009 A20 Operating While Intoxicated Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR 7tIR Revoked 10/01/2009 09/30/2015 A20 Operating While IA IA Intoxicated ,as 7C G Name: Jackson, Tony Charles Marvell DL/ID: 846AA1812 --i G'1 i CO t Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Depaof Itspoat]��-q71�, do hereby certify that I am the custodian of the records held by Driver & Identification Services, that th"truiid ac copy of an official record currently in the custody of said Office, and that I have been authorized by tiie Directc"f 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: Name: Jackson, Tony Charles Marvell DL/ID: 846AA1812 8/14/2018 Driver & Identification Services Iowa Department of Transporation y-� r v CO