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Home My WebLink About19-037I r i CITYF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. ta'b3� (Office Use Only) Fi k,,.. APPLICATION FOR TAXICAB it MOTORIZED PEDICAB VEHICLE DRIVER (Police DepartrjIlil must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to coma ate tWtlieauired" information will result in denial of the application Iowa City, Iowa 3. Contact Information (REQUIRED) 4a. Driver's License expiration date (REQt b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa First Middle 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? _ (� Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other N� 7. Have you been arrested / charged with any traffic offenses in the last five years? Mb Type of offense Where When What happened to the charge? (Circle one) I Convicted Dismissed Deferred Suspended Plead Guilty Other l� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) No (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIF ED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICFA"ft INMIEW You must apply for an individual Department of Criminal Investigation Report (form avaQ "066 request). Iowa City, Iowa I hereb�yyI hav issued to me by the Iowa DepprtmTt of Transportati n a valid Driver's license number Uso�� issued on expiring on 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 theprovision of Title 5, Chapt t 2, of the City Code. (Needs to be fined in front of a Notary Public) Signature of Applicant , Date I),(, STATE OF IOWA ) COUNTY OF JOHNSON ) 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 dfnse `7 Police Chief or 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 `t1�(. I I i Date aerk/TM RPOB"EAPPI-s2oiee�.DOC 04/2018 np I. Pt. LV 17 7. V IF119 ut,s :Vnn No. 8041 P. 04/18/2019 09:19 Yellow Cab fA)03193382103 P.0021002 rnFry ,STATROF IOWA FILE ��_LLL C�Iminal History Record Cli-e Request Porm .5 wwu; «:.;•1i CitY Clerk f was Iowa CitY, • wa To: Iowa Division of Criminal Investigation Support Operations Bnreau, P Floor 213 $. 7a' Street Ues Moines, Iowa 50.319 (515) 724.6066 (515) 7254080 Pat I am roeuestina an rnv crate_ DCI Account Numbers 9967-F (if applicable) From! Yellow Cab of Iowa City 1?.0♦ Box 428 Ibwa City, IA. 52244 (319) 338-9777 Phona• Fax: 019) 339-7302 11 Clhi\ ., 0 09 (6k Waiver ,(n, formation. 'Without a signed waiver from the subject of the reeivest, a aomplgte emrafnai history record may not be releasable, per Code of lows. Chapter 692.2. For cosufete criminal histo obtain a Waiver slonatum irrn., A. ti._ .:_... _ -_ _-- F ry 1 eeor1ilnjorms(rion, as allowed by law, a)ways Waiver Ackases i tweby eye porcnlaslon Ibr thd�ibove requealn; official la oonduu an iowe eriminnl L&tory xnco:d shark with the Dirlafon of Crimind invaads rftn (DCI). Any criminal history dam aonaemld 8M6 [bet is malmelnod by the DCl may be released atmllawad by law. Waiver Signature: IO'WR Crim!' al, xs �or • Reco -d Check ResuI6 .+ (DCI ws only) As of_ a a search of the provided name and date of birth revealed TE OF IOWA/DPS No Iowa Criminal History Record found with DCI APR 18 2019 r DIV F CRIMINAL INVEST Iowa Criminal MatorS .Record atta�'DCI # DCI iiiitials_� DCI -77 (0825/10) Received Time Apr. 18. 9019 9:114 No.6484 Apr.24.2019 5:0/PM DCI IOWA No. 8047 P. 2/2 FILED DISCLAIMER APR 2 6 2019 City Clerk This response can only include public criminal h/storjQYftVCtfpc1wd9wa law, most juvenile records are confldentlal. Confidential juvenile court records, if any, cannot be Included In this response. A signed release authorization is not sufficient to obtain this information from the Divlslon of Criminal Investigation. In order to request the release of confldentlal 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 juvenile sex offenses can be found on the Iowa Sex Offender Registry., htto://www.iowasexoffender,com/. However, even though some information Is available on this site, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenlle records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). FILED APR 2 6 1819 w QJI a City, OOT to aC.tyty to k SMARTER I SIMPLER f CUSTOMER OR�VEIi V'n''`fw-lowadot.gov wa Drivar & idantrfication Servierrs PJ firx J2.'lt Dei f.icines IA 1,33;,6=4 Plx,ne 51-,-714-9174IFax 515.739-1&17 Certified Abstract of Driving Record Inquiry Date: 4/18/2019 DL/ID #: 060BB4823(IA) Customer #: 4522778 Name: Long, Adrian Amara Class: C ID Status: EXP Address: 1100 ARTHUR ST Audit #: 1280070 DL Status: VAL APT P4 Issue Date: 09/06/2016 City/State: IOWA CITY, IA Expiration Date: 08/01/2020 522406619 Mailing Address: 1100 ARTHUR ST APT P4 Mallinp IOWA CITY, IA city/state: 522406619 Endorsements: NONE Restrictions: NONE Date of Birth: 08/01/1991 Sex; F History Information CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Casa Number 3UR 103/26/2015 851869 IIA Name: Long, Adrian Amara DL/ID: 060884823 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: 4/18/2019 / C Driver & Identification Services Iowa Department of Transporation Name: Long, Adrian Amara DL/ID: 060BB4823 Alwx APR 2 6 2019 City Clerk Iowa City, Iowa