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Home My WebLink About18-104IDENTIFICATION NO. j f;; — /rt{ (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required" information will result in denial of the application Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) ' �i Nr� 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) '] y 5. Prior experience in transportation of passengers: First t11M D6 � 7 541 (Cell communication sent via email)Qt,,� jl\1 L LL 10 r 1S Middle Phone:.2-7./, 3./, 3 L :jam 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When it j r� N E2 What happened to the charge? (Circle one) F Z Convicted Dismissed Deferred Suspended Plead Guilty 'Other_ 7. Have you been arrested / charged with any traffic offenses in the last five years? 1 1 �� n Type of offense Where When s E : nw A C_ �L )4, d4r.cj,)1:7--z� — 20 z 1►w�> .rte �vk�� 4 Ly /7 What happened to the charge? Circle one) Iq nvlcted bPmissebl) Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur'seen suspended or revoked in the last five years? j1 U 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) r %I— Middle ._ 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I neby4ertg at I h ve issued to me by the Iowa .De art me t of Transpo at�'gn a alid Driver's license number � �( � issued on expiring on L v — I understand that if 1 falsely answer any questions in this application, that this application may be denied. 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be/ Jsigned in front of a Notary Public) Signature of Applicant Date N ('1 Cl7 C7 STATE OF IOWA— COUNTY OF JOHNSON )) 7 -7- Subscribed and sworn to before me by W;)-Fr-qrq P�pDre_ on' this ,/ _ day of rk--t,L0,F 7n19� �«��MMRtf411tkfeli'k*kR4fY**Rk411Y(*1YfM**feMeR*1rAR41f#It1t4fYRYtkkfyy�!!y4{,{�}}}�t�}}R4M*1ef4##RIR 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 d r' r' license IZ2*7W Sign a of 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. Office Use Only Approved application DCI report State certified driving record Website update /n - �>-a- - / ? Date CIeM1/TA%IORNaADGEAPPL92018awaxled.00C 04/201 8 C210WADOT SMARTER I SIMPLER i CUSTOMER DRIVEN www.lowadotgov Driver d IdMfiifi00ion Swvilm PO Box 9200 I Des Maines, IA 503069204 Phare: 515.244-91241 Fat. 515-M 1637 Certified Abstract of Driving Record Inquiry 10/9/2018 DL/ID #: 409AF8021 (IA) Date: CDL Permit None Customer 5593215 Class: D 0 Nonem Restrictions: C[[--�� O Name: Moore, Wilfred Audit #: 2741294 Address: 427 Ashton PI NE Apt 81 Issue Date: 04/20/2018 Expiration 12/28/2024 CDL Status: Date: rn City/State: Cedar Rapids, IA Endorsements: Chauffeur 3 Status:- 524028368 CDL Cert Status: 'None Mailing 427 Ashton PI NE Apt 81 Restrictions: NONE Address: Restriction None Mailing Cedar Rapids, IA Supplement: City/State: 524028368 Date of 12/28/1980 Birth: Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: v CDL Permit_ 0 Nonem Restrictions: C[[--�� O ID Status: �=-JYConec-') DL Status: :2LfV CDL Status: pollne rn CDL Permit v �J Status:- CDL Cert Status: 'None m CDL Med Status: None :nation Date Conviction Date ACD Explanation JUR County )7/27/2018 09/11/2018 S92 Speed IA Johnson Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 05/29/2018 IA 1050328 Sanctions ype Effective End ACD Explanation JUR Occurrence JUR ancelled 01/28/2017 06/13/2017 WOO Not Entitled to Issuance IA IA Name: Moore, Wilfred DL/ID: 409AF8021 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, 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. ,,Oct. 16:2018,e 9:08AM, C,.,Div of Criminal Investigation 10/03/2016 ":No. 8350w7CP. 2002/002 STATE OF IOWA 4) Criminal History Recoyd Check Request Form TO; fovea Division of Criminal Investigation Support Operations Bureau, Is' Floor 215 E. 7'a Street Des Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Fax DCI Account Number:% (ifappllnble) FrontCi of Iowa City City Clerk's O7ca 410 E. Washillton Street Iowa City, L+ 52240 Phone; 319-356-So41 Fax: 319-356-5497 ca lesting an Iowa Criminal ffistory ]cord Check on :l _ ro Me (mandatory) First Name (mandatory)Middle Name ( ) 2' �� r O I �M a ❑Female Waiver Information: without a signed waiver from 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 information, as allowed by law, always obtain a waiver sillaature from the sublect of the reau&et. Waiver ]Release; I hereby give pemtsslon for the above requening official to cmduct an low. criminal history record cheek with The Division ofC4iminal Imeatigadon (DC), Any criminal history data emmcoting me that is maintained by the DO may be reitbnd y allowed by law. Waiver Signature: Iowa Criminal Histor Record Check Results As of I , 5. 11 a , a search of the provided name and date of birth pl No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DC] # DClinitials ACI -77 (08/25/10) Received Time Oct. 3. 2018 10:33AM No, 6610