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Home My WebLink About18-106CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319)356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. /e) -)f7 LC' (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday) Failure to complete the "required" information will result in denial of the application First Middle 3. Contact Information (REQUIRED) Email:' = /Y phot�ts Qb rt 1 . a, Cell Phone:(dm)Gp,_dvsc- (All written communication sent via email) 4a. Drivers License expiration date (REQUIRE��D��)-/y-a7�go b. Taxicab Business Name (REQUIRED) �l._//,, , Cab 5. Prior experience in transportation of passengers: 9 jt ,s O% QL* Yi/cri Cholo 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? R)o Type of offense Where When � —� C:] r What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Ab Type of offense Where When What happened to the charge? (Circle one) 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? ft)e 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 REQUIRED SIGNATURE AND NOTARY) 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number (�p�(yx/,r�y issued on �-/3 jbLS expiring on �S-/4r-o1oa�. 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, 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 signed in front of a Notary Public) Signature of Applicant,# a/g� Date l��lMf#fkfY llflf4f#4i1f1iYff�f111fltt#1tlff11f1fHY11fi11f11f�11t1i#11N1f1ff114fi Mf-FltflflliflhtlHNlMYf1l�'F�'MMf�11��1M{1f111t!!�'�1�'1 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sv�p t fore me by �,)(� (f firms on this _day of I have reviewed this application, DCI report, and the State certified driving record of this applicant and�havWdetermTned 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 f D ' ar s license 4 ature 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 11-6--1�/ Date Ger AXIDRWBADGEA 920188�.DOC 04/2018 tOl:NoY. 1.2018;! 9: 31 AM Cab Div of Criminal Investigation ffAX)3193382No.0718 P - 1/2;/002 STATE OF IOWA Criminal History Record Check Request Porm To: IOWA Dlvlslon Orcriminsl Investigation SupportOperations Bureau, In Floor 215 E. 71b Street Dat Moines, Iowa 30319, (515) 725-6066 (515) 725-6080 Fax e uestin an Iowa Criminal iXlno, 'iteoord t l`Iame (manGNo» st I S' DCI Account Number. _9967-F (if applicable) Prom( Yellow Cab of Iowa gLty P.U. Box 428 Iowa City, ><A 52,244 (319) 338-9777 Phone; rax; (319) 339-7302 mend Middle Name (recommended[ d I., RMale ❑Female IVa+ver jnformarion Wrthout a signed waiver from the subject of the request, a complete criminal history record m ty not be releasable, per Code of Iowa, Chapter 692.2 For complete criminal history record information, at allowed re law, always obtain a waiver e! natural[ amelia sub act of the r ueat I�U1190 RC%CASE: I hereby give pdmloion kr the above requesting otiicial to conduct an Iowa eriminal Elam . Kation (fir). My eriminal history data Coneemins moo dr meinmined by the DCt maybe released a9:alloweq by Idaw, oak eddl the Division of Odminal Waiver SlrnaYura�C/ �f � it As of mer ace only) �` a search of the provided time aDd date of birth revealed: No Iowa Criminal History Record found with ACT ❑ Iowa Criminal History Record attached,'DCI DCIinitlale � (' (' n DCI -77 (08125/10) Received Time Oct, 31. 2018 1:53PM No, 0639 Nov. 1.2018 9:31AM Div of Criminal Investigation No.0118 P. 2/2 DISCLAIMER This response can only Include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenlle court records, If any, cannot be included in this response. A signed release authorization is not sufficient to obtain this Information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenlle sex offenses can be found on the Iowa Sex Offender Registry. htta://www,iowasexoffender.com/. However, even though some information Is available on this site, the actual records for juveniles may sill/ be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232,147(18). N O_ GD C-) rn Cn 741UWA DOT Sh#i,RTER I SIMPLER I (( STOMIR ORc4E1� m w.iowadot.gov Driver 8 IdamiGaation services PO 0cx'i=,'. Des Vi inaa. IA 63306 4204 Fhcne 51:--711-91711Fax 51r�7;94833 Certified Abstract of Driving Record Inquiry Date: 10/31/2018 DL/ID #: 627XX6064(IA) Customer #: 2375713 Name: Phelps, Gilbert Allan Class: A ID Status: None Address: 1206 E COURT ST Audit #: 9079785 DL Status: VAL Issue Date: 05/13/2015 CDL Status: VAL City/State: IOWA CITY, IA Expiration Date: 05/14/2020 CDL Cert Status: Non-Excepted 522403234 Intrastate Endorsements: Motorcycle CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: Corrective Lenses, Restriction None e CDL Intrastate Only Supplement: Date of Birth: 05/14/1958 0 m Mailing IOWA CITY, IA Sex: M Q-+, City/state: 522403234 History Information 1' rn CLEAR DRIVING RECORD Name: Phelps, Gilbert Allan DL/ID: 627XX6064 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: Name: Phelps, Gilbert Allan DL/ID: 627XX6064 10/31/2018 C� Driver & Identification Services Iowa Department of Transporation