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Home My WebLink About18-110i 1 l 3 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. (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 Last �c (� 1 1. Name (REQUIRED) G-ro- .-t�'e/� t 2. Address (REQUIRED) 1205 tjrmv.St'0r'l PoAyn 9b FIka o� LA s2b93 3. Contact Information (REQUIRED) Email: _5 c oft. CtJeud �,, / Wim, �dU Cell Phone: 31rt Sy 1 US 1 (All written dommunication sent via email) 4a. Driver's License expiration date (REQUIRED) 1\-2-`t-2nas b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When m What happened to the charge? (Circle one) o Convicted Dismissed Deferred Suspended Plead Guilty Othe� yS` 7. Have you been arrested / charged with any traffic offenses in the last five years? j rj Type of offense W hereW hen:_ FTO �rMnlw[u....1"S li-L- 1 13 to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N D Type of offense Where When 9. Have you ever appliedto 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 134AC l9n issued on Ir1q-2olt! expiring on 11.2,4 2425 . 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 provisions of3,�p 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant S�Vkp '-- Date 11 • Z3 ZO )� f f1fNNNlf�ffNlNNfyfyNMNtfliff 1fN1NRNNf f f4�FiftNlfNlf Yl1fNNlfilNNNNNfNf!lflplrNf-f1f1N{,ff!ll1NlNlNlN4lfMlN11f1NfN11! STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 5'c -t-_12 G f -a on this aZ i day of NnJe"e! ?&?jB I have reviewed this application, DCI report, and the State certified driving record of this applicant and hOv� detetttlfned that there is no information which would indicate that the issuance would be detrimental to the safety, health'o--r welf f resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). a Expiration date iv se I1 Zy-z N r z7 iB Signatur 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. igna ure of City Clerk,6r designee Date 1NN111NNlNNltfflffNlNlYlf Nf11f1f{..fffllf f 1f 11f.1ffNfNft.lf!!f!!f}!lfl1ff11f�fyNf!{..l.ff.N1N1NN Office Use Only Approved application DCI report State certified driving record Website update C7akrTAXIDRNMADGEAPPL92018ame W.DOC 04/2018 410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gl7y Dr6rM 8 Identification 8W411 q PO fox 92041 Des Manes- IA 5030fr9201 Phone 515-244-91241Fax 515.239-1897 Certified Abstract of Driving Record Inquiry Date: 11/9/2018 DL/ID #: 139AC1873(IA) Customer #: 3383405 Name: Grau, Scott Robert Class: D ID Status: None Address: 120 S MAIN ST APT Audit #: 1935799 DL Status: VAL 06/07/2014 4 M14 Fail to Obey Traffic Johnson IA Issue Date: 07/05/2017 CDL Status: None City/State: ELKADER, IA 52043 Expiration Date: 11/24/2018 CDL Cert Status: None Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: PO BOX 96 Restrictions: Corrective Lenses Restriction None 05/23/2017 06/05/2017 M42 Improper Lane Supplement: Date of Birth: 11/24/1955 Mailing ELKADER IA Sex: M Johnson City/State: 520430046 Sign/Signal History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 12/06/2013 01/08/2014 M14 Fail to Obey Traffic Johnson IA SI n SI nal 06/07/2014 11/19/2014 M14 Fail to Obey Traffic Johnson IA Sin 51 nal 02/07/2015 06/10/2015 M14 Fail to Obey Traffic Johnson IA SI n SI nal 05/23/2017 06/05/2017 Defective Lights Linn IA 05/23/2017 06/05/2017 M42 Improper Lane Linn (changinglanes 04/06/2018 08/02/2018 M34 Fall to Obey Traffic Johnson Sign/Signal Accidents - Accident involvement indicated does NOT mean the individual was at .} fault or given a citation. J Accident Date I Case Number JUR 112/06/2013 771266 IA Name: Grau, Scott Robert DL/ID: 139AC1873 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: Glu, Scott Robert DL/ID: 139AC1873 11/9/2018 01112 Driver & Identification Services Iowa Department of Transporation N O p N iv J Nov.15.2018 9:47AM DCI IOWA 11109/2018 10:10 Yellow Cab No. 1245 P. 1/3 0:4319 338 Z708 P.0021002 r. STATE OF IOWA Criminal History Record Check Request Form To; Iowa Division of Criminal lnvestlgatlou Support Operations l3ureau, I" Floor 215 E 7" Street Des Molhcs, lows 50319 (515) 725 6066 (515) 725-6080 Fax I am requesting an Iowa Criminal ifiatnrv'R P.rnr i rh.rie DCI Account Number, 9967-F �(ifepplieebla) From: Yellow Cab of Iowa Clty P.O. Box 428 �— Biwa City, LL 52244 (319) 338-9777 Phone• Fax_ J719) 339-7302 I,aet Name pnsnd) }First Name (mandato y) Middle Name (raeommanM' GV S G(.) 1-+- � Data of Birtb (mandato) Creuder (maodarory) Social•Seeurl Number (ieewmmendad Smale ❑Female Waiver Information. without a slgped ivalver from the subject or the reggeat, a gomplete criminal history record qmy not be releasable, per Code of lows, Chapter 592.2. For com lets criminal history record infor•mmAon, a8 allowed by law, always obtain a waiver signature from the subject of the re uem Waiver Release: I hereby gale pennisilon the the above request!50 official to conduct an Iowa criminal history rdoad ohook whh the Division orcrim)nal Invesd{anon (DCq. Any eriminai hlcroty den oonoemlhg me mtalned by the DCI relay be rokaeed iFgallowc4 by law. - Waiver Signatur As of I I ' 15 ' I $ a search, of the provided name and date of birth No Iowa Criminal History Record found with DCI 26129.'1' Iowa Criminal Rigtory 1 ecoid attached,•DCI il_ DCI i'�tials DSI=Q7-(o8n5n0) Ao.e;,,sa r m, Nr;, 0 MA 1o•117nl Nn nFi� Nov. 15. 2018 9:48AM DCI IOWA No. 1245 P. 2/3 IOWA CRIMINAL HISTORY DCI 00261899 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2018/11/15 DCI:00261899 NAME: GRAD, SCOTT ROBERT DOE SER RAC HGT WOT EYE HAIR SIGN POB 19551124 M W 601 168 BLU BRO MED IA ADDITIONAL IDENTIFIERS SC BACK CCH RECORD w** 01 ARRESTED/TAKEN INTO CUSTODY 19800129 AGENCY: IA0770300 DES MOINES PD CHARGE NO- 01 IA STATUTE IA321-281 OMVUI TRK#: L17524201 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE: IA321-281 OMVUI • CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L17524201 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT PLEAD GUILTY 19800418 PROBATION lY 19800418 DEFERRED SENTENCE lY 19600418 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 EE RELEASED TO NON -LAW ENFORCEMENT AOENCIES'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 r^� COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION omal N cx� Nov.15.2018 9:48AM DCI IOWA No.1245 P. 3/3 DISCLAIMER This response can only Include pu4l/c'6rlminal hlstorydatEl. Under Iowa few, most juvenile records are confidential. Conffdentiallovenlle court records, If any, cannot be Included In this response,:A slgned release outhdrlxatlon Is not sufficient to obtain this lnformatlon from the Dlvlslon'of Criminal Investigation. In order to request the release of confidentlaIjuventle records; If any, an appl(ca(!on must be filed ,pursuant to Iowa Code. section 232.147(18), Additionally, criminal history data concerning convictions for certaln Juvenfle sax offenses can be found on the Iowa Sax Offender. Registry. - s wv , o s o e r , yowever, sten though some Infcrmaflen Is avalloble on this site, tho actual recor s forJuvenllos may sAll de confidential and any confidential Juvenile records cannot ba provided wlth'th/s record, In order to request the release of confldentlaIJuyenlle.reccrdo If any, an Oppitcatlon must ba filed pursuant to Iowa Code secflon 232,147(19), o m N ro i 4