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Home My WebLink About19-050• � r t CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 3S6-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. IR, b51D (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 First Middle 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? YtLl Type ofoffense I /, Where / When / > What happened to the charge? (Circle one) (,UWL 1 UM ru' 0/1-1/ t c 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? 4Z 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) 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 herebyth h s to me b the Iowa D pef Trans rtation a valid Driver's license number ssued on Airingono. I understand that 'rf I falsely�ans many questio in is application, that this app i tione 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 r 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applic Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by je- f � `.\ li - f .I on this a day of *******+***+*»***+**********#***********+*+*+++AMM**+x.*+**++*##****»»******.********+*+•+*.*********»**+**. 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 0 /-,o Z °Z� Signature , Chief or designee �_ /1 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. 42V_66 Le I�L I - — 72 1? /) 9 ig ture of City Clerk esignee Oate Office Use Only Approved application DCI report _4C State certified driving record r— xA Website update Cj: .� co Y U1 0 Cled AXIDRIVBADGEAPPL92018.ended.00C 04/2018 AKtS ''j % 10WADOT www.iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: Address: City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: Convictions 7/5/2019 4327574 Fowler, Eric Dean Page 1 of 2 Driver & Wolawmation Ill PO Box 92041 Des Moines, IA 50010&9204 More: 515.244-91241 Fax. 515.239} 1837 Certified Abstract of Driving Record DL/ID #: 428XX5189 (IA) CDL Permit Class: None Class: D Audit #: 3404760 735 MICHEAL ST APT 4 Issue Date: 11/20/2018 Expiration 08/23/2025 Date: IOWA CITY, IA 52246 Endorsements: Chauffeur 2 735 MICHEAL ST APT 4 Restrictions: Corrective Lenses, Left and Right Outside Mirrors Restriction None IOWA CITY, IA 52246 Supplement: 8/23/1973 M History Information CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: None None None None None VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation JUR County 05/14/2018 ,08/14/2018 M85 Texting While Driving IIA Johnson Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 05/14/2018 JA .1047866 no Name: Fowler, Eric Dean DL/ID: 428XX5189 (IA) c Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department eflTfansp�1orr]] ation do hereby certify that I am the custodian of the records held by Driver & Identification Services, that this is a KE—andurateg"2 p(y of an official record currently in the custody of said office, and that I have been authorized by the Direct( 11 Ora Dega—U0ent of Transportation to so certify. CD XCO T� In witness whereof, I have caused my signature and the seal of the Department to be set upon this docume,j at Ankeny, Iowa this date: http:// 172.29.254.5 5/drivers/reports/customerhistory/certifieddrivingrecord.aspx 7/5/2019 Name: Fowler, Eric Dean DL/ID: 428XX5189 (IA) Page 2 of 2 7/5/2019 d9a"w Akyz�j- Driver & Identification Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 7/5/2019 )14irY u u i iuvvm No. tlIGL r. 9/4 Fro....-.... ... .., vv. .....y Bark vuwo 010 36615407 06/26/2018 00i" "60 r.uua/002 STATE OF IOWA 0 Criminal History Record Check Request Form To: Iowa (Division of Criminal Investigation. Support Operations Bureau, In Floor 215 E. 7° Street Des Moines, Iowa 50319 (515) 725.6066 (515) 725-6000 Fax I am rennestino ao Tn. Lr, ...-. b ----A 0 ..0 i y� t DCI Account Number: 405a - (if epplicabic) From: Cit of Iowa city City Clerk's Otfice 410 E. Washington Street Iowa city, IA 52240 Phone: 319-356-5041 Far: 319456-5497 Last Name (mand.tary) First Namemsnme, Middle Name (rero;wncnded) (, Date of Birth (mandebry) Gender mmdatory) Social Security Nnmber ratwmmenem ZJ Male ❑Female .. t Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable per Code of lows, Chapter 692.2. Fore eta criminal history record information, as allowed bylaw, always obtain a waiver signature (tom the sub act of Ne request Waiver AlUICade: I hacby give permission for the above requesting ci ;ew to conduct w lows ceiminat history record cheek with the Division of Crimh, hu"'Busallon (DCI). Any cdminai history dela eohoeming me that Is maintdned by the DCI may be mieased Its flowed by law, IWaiverSignrtture: �— Iowa Criminal History Record Check Results Cl use onlyk 0 to 0. As of a search of the provided name and dWo,bril) ,1�1 ifov B�%led: P� �' z O N No lows Criminal History Record found with IiDy :' ate' LL Lea ? D z his criminal a ❑ Iowa Criminal history Record attached, DCI ! _ ry results ; IL o o DCI initials, '%�re„r'' • .... ��Dr,.`` DCI -77 (08/25/10) .......... Kecelved Itme Jun. 25. 7019 5;4/AM No, 1112