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Home My WebLink About19-048f . 44 1 l t CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. 111� — 04-1 8 (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 Last 3. Contact Information (REQUIRED) Email: First (All written communication sent via 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) �L d O t J Cab 5. Prior experience in transportation of passengers: _ N C7 Yl Q–, 03 Middle Phone: 314 - 53e—c? I 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? -O Type of offense Where -7- When What 71 What happened to the charge? (Circle one)o f r� _. Convicted Dismissed Deferred Suspended Plead -' Oth 7. Have you been arrested/ charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where When 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? lyn 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) KtQUIKtD SIGNAL UKt AND 04/2018 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Drivers license number 2-) —7 4 A Si ?> I issued on _expiring on 3 /.-j-7/ a,2 . 1 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, oche City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) sworn Subscribed and orn to before me by i+ _.JF day of rA on this / \ i R - CHRISTINE OLNEYJ otary Public in ardf6rWStateof Iowa = um r 2 ti M Commissm Expires aw I have reviewed this application, DCI report, and the State certified driving record of this applicapt and bave determined that there is no information which would indicate that the issuance would be detrimental to the satat&eaftfi or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). ca Expiration date of Driver's license n CD 7Z N i cn b II.B lel �: Sig at re 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. Office Use Only Approved application DCI report State certified driving record Website update Gerk "IDRIVBADGEAP L92018amended.DOC Date 04/2018 Jun.17.2019 12:53PM DCI IOWA No. 5937 P. 2 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. 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 Division of Criminal Investigation. In order to request the release of confidential 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. http.,Ilwww.iowasexoffender.com/. However, even though some information is available on this site, the actual records forjuveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). OBlJun_17_2019);12:53.PN¢Cab DCI IOWA (FAX)318 338 N °: 5 9 3 7 P.. 1)021002 STATE . IOWA 6iminal History Record Check f?. ciNS^ Tk S:t:FYL`40Y' a'Request1 el i DCI Aocouht Number_ 9967-F 'Middl Name (rccommoodod) 10- 1'0: Iowa bivision of Criminal Investigation From Yellow Cab of Iowa Ci Support Opetatiow Bureau, JIT P.O. Box 428 215,E. 7e' Sirret �'�)vlale Des Molnel, Iowa 50319 Iowa City, U. 52244 (315) 7256066 (515) 725-6080 Fax (3 19) 338-9777 '. ?bona; _ ' C4 No Iowa CriminalHisfokty Record found with DCI Fax: (319)339-7302 I am re uesting an IDWh Criminal history Record Check on: Last Nome mantle a Y)jQ'-" 'Middl Name (rccommoodod) 10- �rOJ4 pate of Blrtlt (mindstory)ender mandatory) �Social•S"tiil Nmnb recomaionded) �'�)vlale OFemaIe :3 ?—G, - ka— 3 9'31 rrwrper injorraaironr Without a sl;ned vvalyer from'the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 02.2, For complete criminal history.reecord information, ag allowed by lawi 4ways Waiver Release: I hercbygivc pctmtuion for tho above rsqualtina ofeolal to conduor an Iowa crlmlhal blswryrecord check with the Division of Criminal Invarigation (DCr). Any criminal history dam cooaem0s; me the[ Is roWntalned bythe DX1 may be te)oerad of allowed b'y law. Waiver Slgnature:"_ i.owa t"T1iI111ra1 rirg;GOKx KeCOI'U ugeeg 3ie3ma-1o°"tthtirta(zrz.. ... �cfwcanry) As of. a searai} of the provided name and date OAA -revealed: C4 No Iowa CriminalHisfokty Record found with DCI -_, d; : �o r+a (t . • �`Sti� Dz N O D Iowa Criminal History Record attaohed,'DCI -9 %, a,............ • Lo,. ; '� --- --K�rsemin•al Ory„nrnbnnin�nPU„• .; m � v to „/'y 1 It✓� �d�.c• -i DCT initials ` DCI -77 (08125/10) Received Time Jun, 11, 2019'11,;03AM,'No.4921. /C,dn410WAD0T LE t CUSTOMER DRIVER W+�nJVid �C)W8d0$.C�OV SMARTER 59H�P R Driver & Iden0mat ion Services Phi Box 9204; Des biomes, til 60306 1 Plig".5ta244-9824 B Fac 515.235.1631 Inquiry 6/11/2019 Date: 1100 ARTHUR ST APT Customer #: 4300984 Name: Johnson, Shagdreal IOWA CRY, IA 52240 Gerhart Address: 1100 ARTHUR ST APT 3/27/1970 ' 143 City/State: IOWA CITY, IA 52240 Mailing 1100 ARTHUR ST APT Address: 143 Mailing IOWA CRY, IA 52240 City/State: Date of 3/27/1970 ' Birth: Sex: M Certified Abstract of Driving Record DL/ID #: 217AA3731 (IA) CDL Permit Class: None Class: C Audit #: 8464299 Issue Date: 09/20/2014 Expiration 03/27/2022 Date: Endorsements: NONE Restrictions: NONE Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Johnson, Shandreal Gerhart DL/ID: 217AA3731 (IA) CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None EXP VAL None ELG None 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 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: `ANT OF F e41. A^r"og 6/11/2019 L occ�Driver & Identification Services Iowa Department of Transportation Name: Johnson, Shandreal Gerhart DL/ID: 217AA3731 (IA)