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Home My WebLink About19-0450' 1 l 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. 1 —� (Office Use t)nl 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 Last First Middle 2. Address (REQUIRED) X255 S• pi✓e-4SIc16, V/1' 3. Contact Information (REQUIRED) Email _SCS o i�, �a%1✓/C ,y,i cell Phone: 3 /P S%? S�y? (M written comr6unication sentviaemail)` 4a. Driver's License expiration date (REQUIRED) I � 2 / b.' 5. 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where I I When e rr ;�.J ';?eKl? What happened to the charge? (Circle one) Jw Convicted Dismissed a erred Suspended Plead Guilty -`ether Have you been arrested / charged with any traffic offenses in the last five years? 7 -- n o Type of offense F.. / Y-, /-� ) Where When SrkerX � .LC A&KV ene to the cfharge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ll/ C) Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) /I/0 (SECOND NV IAMY) 04/2018 N O What happened to the charge? (Circle one) Jw Convicted Dismissed a erred Suspended Plead Guilty -`ether Have you been arrested / charged with any traffic offenses in the last five years? 7 -- n o Type of offense F.. / Y-, /-� ) Where When SrkerX � .LC A&KV ene to the cfharge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ll/ C) Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) /I/0 (SECOND NV IAMY) 04/2018 I Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 he certify that I have issued to me by the Iowa Re artment��f Transportation a valid Driver's license number Z �C2��/ issued on 1 7 .fO/jfexpiring on d.2. X0.2 1 understand that if I falsely answer any questions in this application, that this application may be denied. 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/Tide 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant `� (C Date 6 O C STATE OF IOWA 0 COUNTY OF JOHNSON ) M a M Subscribed and s to before me by ) A-e�r it LrA V) LQ (-('L aFi thi � 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 Dover's license Z�o Z dd Signature o" f Police Chief or designee 6 -le /R 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. /'1 - ark or Office Use Only Approved application DCI report State certified driving record Website update CP -f0 -I cj Date GaM/rM1DR1V64DGEAPPL920188m dW DOC 0412018 I May -29,2019 �4:03Pcab DCI IOWA Y fAM19938 NoV 3 16 9 P. ,1/ 002 STATE OF IOWA Criminal Ristory Record Check ' Request Form To: Iowa DfvLvfon of Criminal Inv"-'&atIon Support operations Bureau, In Floor 215.1t. 7`s Street Det Moines, Iowa 50319 (515) 725-6066 (515) 725-6080 Fax e.r0r' "Sri ve✓J DCI Account Number: 9967-F . ? --- (if applicable) Froin; Yellow Cab of Iowa City P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 Phone; laze (319) 339-7302 � .pari _ �`•. pZ •., /�`�� `. P/Male ❑Female J 7/ � � �✓ - Waiverl7{iDrmatlOn; Without a Agned yvaiver from the subj Kt of the regpasf,•a comp)goe criminal history record may not be relestablq per Coda of Iowa, Chapter 6922. For P,omoltte criminal hfstoryrecoro 1nFormgiion, as allowed bylaw, µ)ways Obtain a waiver sknature fromthe�ectof the request. Waiver .Release: I ncreby sive patminlon for the %bovc Inveadtiulon (DCI), Airy edmfml hiamry dau oonoamfht ma Waiver Official to tandem so Towa criminal history. »^"N check with the Division ofCeWnal (DCI ole only) As of a search of the provided name and date of b' revealed- 8 ATE OF IOWA/DPS i No Iowa Criminal.Iii R000rd found with DCT MAY 22 2019 1 g1 (� Iowa CriYninal History I eeord ajtached,'DCI # l� t0 5 DIV F CRIMINAL. INVEST DCI initials_ DCI -77 (08/25/10) Received Time May -22. 2019 12:42PM No.2355' May. 29. 2019 4: D4PM v DCI:00706957 NAME: GEROT, STEVEN ALAN. DOB SEX RAC 19570922 M W ADDITIONAL IDENTIFIERS DCI IOWA IOWA CRIMINAL HISTORY NON CONVICTION HGT WGT EYE HAIR 506 200 BRO GAY CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20030912 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(2) THEFT 2ND TAM 100953201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO D15T COURT COUNT NO- 01 IA STATUTE; IA714.2(2) DCI 00706957 PAGE i OF 2 DATE PRINTED - 2019/05/29 SKN POB IA THEFT 2ND DEGREE - 1978 COURT CASE ID; 06521 FECROG6430 CHARGE CLASS: NON CONVICTION TRK#: 100953201 RESTITUTION SENTENCE DISE EFF DAT DEFERRED JUDGEMENT 20040709 PROBATION 3Y 20040709 DISCHARGED FROM 20121207 DEFERRED JUDGEMENT No, 3169 An arrest without disposition is not an indication of guilt. This record �a maintained by the Iowa Division Of Criminal Investigation, Bureau Of o .n Identification is a public record but can only be released to non -law n c enforcement agencies by the DCI. > r._ This response can only include public criminal history data. Under Iowa lgR,C-) C:) most juvenile records are confidential. Confidential juvenile court recora5 r �0 if any, cannot be included in this response. A signed release authoriaati(j5M is not sufficient to obtain this information from the Division of criminate' 'r Investigation. In order to request the release of confidential juvenile ):' r 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: http://www.iowaoexoffender,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 rcqueat the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATX014 THIS RECORD IS P. 2/3 ow 1.may. a LU19 4:04PM DCI IOWA No. 3169 P. 3/3 . EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION via Q010WADOT SMARTER I SIMPLER 105TUMER p'RIYE}l VJL t1N.�OiriFaCipt gCIV Driver & Idemifiomion Services PO Box M I Des tecinm IA M06*204 Phone. 5115-244-9124 1 Far Si5.239.1837 Certified Abstract of Driving Record Inquiry Date: 5/22/2019 DL/ID #: 959ZZ3004 (IA) Customer #: 1549690 Name: Gerot, Steven Alan Class: C ID Status: None Address: 2254 S RIVERSIDE Audit #: 3227086 DL Status: VAL DR TRLR 42 Convictions CDL Status: None CDL Cert Status: Non -Excepted Intrastate CDL Med Status: None Restriction None Supplement: N O ::v --C2 c Citation Date .,Issue Date: 09/24/2018 City/State: IOWA CITY, IA Expiration Date: 09/22/2026 Fail to Obey Traffic SI n SI nal 522465850 03/09/2016 04/02/2016 S92 Seed Endorsements: Motorcycle Mailing Address: 2254 S RIVERSIDE" Restrictions: NONE DR TRLR 42 - Date of Birth: 09/22/1957 Mailing IOWA CITY, IA Sex: M City/State: 522465850 History Information Convictions CDL Status: None CDL Cert Status: Non -Excepted Intrastate CDL Med Status: None Restriction None Supplement: N O ::v --C2 c Citation Date Conviction Date ACD Explanation Coun UR-- OZ/05/2015 07/07/2015 M14 Fail to Obey Traffic SI n SI nal Johnson "'C 03/09/2016 04/02/2016 S92 Seed Johnson Oit,�^ 08/09/2018 10/09/2018 M70 Improper Passing Johnson IA r Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Gerot, Steven Alan DL/ID: 959ZZ3004 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: Genot, Steven Alan DL/ID: 959ZZ3004 5/22/2019 Driver & Identification Services Iowa Department of Transporation -6 CSC N O �o D=i r �� rn D r