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Home My WebLink About18-118� l 1 i III bit� r• Aim 11;Q CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) i IDENTIFICATION NO. _/�0 l 'Q> (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 Sa-M v� L 2. Address (REQUIRED) ?dI S- 7r -k AVE loves{ ci-rj lA sa- NG 3. Contact Information (REQUIRED) Email: po,rso,,i3eseS-Z2'-tai•/. co,., Cell Phone: _3/9-5,//-ql.Z (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 0;7, /I I- / ",D A5' b. Taxicab Business Name (REQUIRED) Y&kotJ CA 13 OP /ow4 r-i—.f 5. Prior experience in transportation of passengers: ' Z Yc-4a S 04C #91-1 V/. )67 —(+1r( r,) 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? /it') Type of offense Where When G3 What happened to the charge? (Circle one) ._.. N Convicted Dismissed Deferred Suspended Plead Guilty \ Other ) 3 7. Have you been arrested/ charged with any traffic offenses in the last five years? NG Type of offense Where When- What hen What happened 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? Nu 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) Nd (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 43V Za o578, issued on o� /is /id expiring on off/ A/zS I understand that iffalsely 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 of Title 5, Chap the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date /4/Z1//0— STATE 4/Z1//8— STATE OF IOWA ) — COUNTY OF JOHNSON ) Subscribed and sworn to before me b � n Y �Qu^ e S S ro CS rn C on this day of 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 of Driver's license' ' Signature K5Is ief odesignee 1 Daw 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. Of Office Use Only Approved application DCI report State certified driving record Website update /,� -a/ -ice Date aerr✓rnxioRiveuoceAnvai9201eemode .DOC 04/2018 ARTS Page 1 of 2 C210WA00T SMARTER I SIMPLER I CUSTOMER DRIVEN www. 10W8C10C g0 Inquiry Date: Customer Name: 12/18/2018 4732685 Dnwr 41 W4ndfiapon si►mo4K PO Box 92041 Des MoYles, IA 503069204 PW*: 515.244-91241 Far. 515.239.1837 Certified Abstract of Driving Record DL/ID #: 434ZZ0578(IA) CDL Permit Class: None Class: D Parsons, James Samuel Audit #: 2549359 Address: 801 S 7TH AVE City/State: IOWA CITY, IA Issue Date: 02/15/2018 Expiration 02/12/2025 Date: Endorsements: Chauffeur 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Parsons, lames Samuel DL/ID: 434ZZ0578 (IA) CDL Permit Issue None Date: CDL Permit 522406205 Mailing 801 S 7TH AVE Address: None Mailing IOWA CITY, IA City/State: 522406205 Date of 2/12/1981 Birth: None Sex: M Issue Date: 02/15/2018 Expiration 02/12/2025 Date: Endorsements: Chauffeur 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Parsons, lames Samuel DL/ID: 434ZZ0578 (IA) CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None 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 ac'turate 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,,,dt Ankeny, Iowa this date: —- MEHi 12/18/2018 .. �� Driver & Identification Services Iowa Department of Transportation Name: Parsons, James Samuel DL/ID: 434ZZ0578 (IA) http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 12/18/2018 12/,De c. 19. 20 18. 12: 26PM[ab To: DCI IOWA ffAX)319338Z o. 5944 P., L002 if STATE OF IOWA Criminal Mstofy. Record Check ' Request Form V DCI Account Number: 967—F cu applicable) Iowa Dlvlsion of criminal Inve0ption Support Operations Bureau, i" Floor 215 L 7" Street Des Moines, Iowa 50319 (515) 725-6066 (515) 725-6080 ,Fax Probe: Tlellow Cab of Towa City P.O. Box 428 Iowa City, Li. 52244 (319)338-9777 Phones 1tax: 0319) 399-7302 I am uestin an Iowa Criminal Hist Record Check on: ` LastNamo. raaya iNdme mend Middle Name (recommended) � Sc►^1S �iv✓1G�J S, Y-1vC—Z_- Date of Birth (mandatory) (render (manduoc» 'Social Securi Numbs racommeedad C) nMale ❑Female Sos - 3 sl Z°J Waiverinformaflon: Withouta signed waiver'7rom the sabjoet oftbe regµest, a eomplgte;•imine) history rerd may not be releasable; per Code of Iowa, Chapter 692.2. For complete crimco inal historyreeor� information, as allowed by laver ajways obtain a waiver signature fr m the sub ect,of the ra east. Waiver Aelease: i hocby give pemri"ion for tho.above requesting official m Ioonditet w Iowa criminal bvtory rcoord shade with the 1Nvisian of Criminal nva[igrtion (DCq, My aunuul history dare wncsanin me that is mat. by DC7 be mlewed acallowell bylaw. Waiver Signature; ivvva l 11iR111a1 [a 1S-- KeCOrci C heck Results (DCl use only) As of a search,• of the provided name and date of birth reveled:.. No Iowa Criminal History Record found with DCT ❑ Iowa Criminal History Record attached, DCI # I a,,, DCI itritials, r a -- DCI-77 (08/25/10) Received Time Dec. 18. 2018 12:26PM No. 5807,