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Home My WebLink About19-019` IDENTIFICATION NO. t, �.\ — O \ 1 r 1 (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) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required" information will result in denial of the app/ication Iowa City. Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) L./Xi y"'5 C l/ fro+( 51ev-7 2. Address (REQUIRED) I Ld9 Lon 74 nr<f! Or 3. Contact Information (REQUIRED) Email: 64,.,l • COwr Cell Phone: 3195iY wfo (All written communication sent via email) 4a. Drivers License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 5% irkrs O" i,, ),/ 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? iu0 Tvce of offense What happened to the charge? (Circle one) Where When City Clerk Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Tvce of offense What happened to the charge? (Circle one) Where vo When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? i't i Tvce of offense Where When Failvie/aY,dW le ✓a ct� 7- )I-/ 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) nn (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 Drivers license number a ss vv �! 9 `�°/ issued on y -I F I� expiring on I understand that if 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date -7L)J)z STATE OF IOWA ) i i-�^=-� _ *��^�*f•� COUNTY OF JOHNSON ) Subscribed and swom to before me by or N S nw, on this g day of 4r c�r. ab 1 Notgry.P-_ublie, in and for the State of'lowa 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, heakWibr Ifar dents of the City of Iowa City (Title 5, Chapter 2, City Code). �1 �i Expiration date of Driver's license �y /�� MAR 0 8 2019 7 City Clerk 316 II Iowa City, Iowa Signa o i hief or de nee I FDate 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. Clerk or Office Use Only Approved application DCI report State certified driving record Website update QwkrrAXIDRN64DGEAPPl92018sm ded.Doc 3-8-/i 04/2018 C410WADOT SMARTER I SIMPLER I CUSTOMER'DRIVEII V11U'ifhtU'101N8d0 13V Drtvef $ Iaenacation Seryw s PO Box 92aki I Des Minim IA 503I)MM Phone" 515740-'91741 Fax: 515759./1187 Certified Abstract of Driving Record Inquiry Date: 2/28/2019 DL/ID #: 255DD4944 (IA) Customer #: 4329777 Name: Williams, Clifford Class: D ID Status: None Steven Address: 1015 W BENTON ST Audit #: 1752853 DL Status: VAL APT 45 Issue Date: 04/18/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/04/2025 CDL Cert Status: None 522465116 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1015 W BENTON ST Restrictions: Corrective Lenses Restriction None APT 45 Supplement: Date of Birth: 01/04/1980 Mailing IOWA CITY, IA Sex: M City/State: 522465116 History Information Convictions Citation Date Conviction Date ACD Ex lanation County JUR 01/15/2014 07/31/2014 M14 Fail to Obey Traffic Si n/SI nal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number JUR 101/24/2019 1094341 IA Name: Williams, Clifford Steven DL/ID: 255DD4944 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: ,I - - . .Ca Lt5 :J 02j. r l�M rip r■ r Lai TAh3l933e2'"c.OV6i6 • ' 21002 STATE OF IOWA oti'krl Criminal History Record Check.Request' corm I To: Iowa Divslon of Criminal Invadtlgation Suppnrt Opers-tions Bureau, l" Floor '-15 B.7'strett _• Du Nfalncs, Iowa 50319 ($LS) 725-6066 (515) 725-6050 Fax I =.•n reauestina on lnwa Criminal Hlrte:v Record Chrak nn, i DC1 Account Number: 9967-F [ (If ipplkable) Frorot. Yellow Gab of lows Cite P.O. B04.428 Iowa City, L1. 52244 (319)3399777 Fhone- Faxt (319)3397302 Last Narne oun:uaq) =tc 11idd1 Norrie Crasammcna al _� 1 rst Name (nwtt/O i 6- Date of Birth (mndaroyp f''Geatler(msoaaro � -Soelal• ecuritvNumb er(,cmorocc cd) O(-Oy-$ D �ivlafe ❑ktemala 5l4'�/'3 -96/G iIlaivar rufOrtrr¢!i0%1: Without t epcd waiver from the subject of the raqucst, a eotaplete trimlonl history record may not 4 f be releasable, per Cade of EMS, Chapter 692.1. For to�7t l Tt to crimlonl history -record Information, aS allowed by jaw, always } k obtain a walver signature from the subiuct•of thb,reCUest MezNaf Releaset(homw Stye P=nt:rkafoeofo:16 to =%Utt aI:awk Cimizal th-myt;. ye:`•.e'e w:h 09 D:wton o: Jxrtrllfndoa (DCI). A,sy edcafnal hh:ory date ooda`mlne Ina tis n 16Wncd by tto DCT may bo rdosead u•sllowod by W. Waiver signaturi i Xo�va G 'urinal is onr Record Check Results f (HCl oaely) U) 7 Ce AS o. a search of the provided na!nc asci date of birth reve� ed: b z m -n J{� ' No Iowa Criminal Histq,g Record found with DC? I`k .- / h r o_ D jj '. E z Q iawa (-'XhI 3121 Histo-ey RCCOT , eitacL6a, DCl 1, __ M DCI lgitials� — — f, 't DCI -77 (OWS/10) Received ii Ie F:o, 28. 919 2:53?4 No. 7423 i