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HomeMy WebLinkAbout19-083IDENTIFICATION NO. /1-©�� r (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 application Iowa City. Iowa 52240-1826 (319) 356-5040 Last First (319) 356-5497 FAX Middle 1. Name (REQUIRED) 2. Address (REQUIRED)�Qd p �rp�� /�/J� r//pS I.( C,114 �a a�lo 3. Contact Information (REQUIRED) Email: AOyEOn/Re dCD��ny>loo��m Cell Phone: h,// 3.75- lo?g/ (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When a wL 41A".4- Ch i990 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil Other Have you been arrested / charged with any traffic offenses in the last five years? /V/> Type of offense Where When What happened to the charge? (Circle one) Convicted ismissed Deferred Suspended Plead Guilty Other 8. Has your driver's licens r chauffeur's icense been suspended or revoked in the last five years? p04 Tyne 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) 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 Driver's license number /flog Cl 7� lz issued on f -/y /g 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 the provision"Title 5, Chapter 2�f the City Code. (Needs to be signed in front of a Notary Public) f{Y{{Y{{{!f!fllfYYYyf1f!!fY{{f{!1f!!Y{}f{!!fY'Yi{111MY'YflflflT{4tf{f!f{fRli{fIfYYYifffllYMYfyfllfYNflff{{f!t!f{#{!!!M/{ff!{{!{yflYt!{fylfY!{�r,� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by � R ti i Pyau��� on this day of IA Ire \i - .7-01 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 DrivWl 3 ZO ZO 9-7 9—OB -/5 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. Clerk or Office Use Only Approved application DCI report State certified driving record Website update it -8 -/C-1, Date CIeM AXIDRIVBADGEAPPL920189me etl.DOC /.2018 1 07PM DCI IOWA1 11 1b4/201 [ 11.49YeHOWCab t: 2708 P.002 Cri STATE OF IOWA minal Mstory Record Check Request Form u\ " "My a tr; •" 1DCI Account Number: 9967-F (ifapplicsble) Mall ps'ILL3 WM9lpte4 forme to: Send results to: Iowa AiviWon of Criminai Iavestl8etion ' Name of Iowa City Support Oporadonl Bureau, 10 Flovr —N"o Iowa CFimu�y�Lecoxd�'C aimm _Yellaw�ab 215 R 7a Street Address 11.0. Box 428 Des M6ines, Iowa 50319 y1 y4'ae (515) 725-6066 Iowa MY, Iowa 52244 (515)725-6086 Fax T1A 1^.JJIN 1 �I IG(ll11i� }..4yk,11 �y}II{ ! ��541 P llr}d TII IS J44..1��{(`It 1�2�T111y N(2�' f(�`�tl'.: y. Phone (319) 338-9777 J 11�uV 6H t ,I y}�t �(�{'y I �Q �ilt4i Fax 919-359.4142 I arn'requestina an'Iowa Criminal Flistory Record rhemk nn! -l��IA.� .I'( .^ tuff. 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S. l � .{ / .,Y�• -. �� �arst�rxa+�Y®sia�•rp Iowa Criminal History Record Check Results v 'co,' .As of i ` 1 a search of the provided name and date ofbirth revealedfl ,LU —N"o Iowa CFimu�y�Lecoxd�'C aimm qa lowa Criminal History'', Record attached, DCI # DCI initials DCI -77 (updated 06.262018) Pagel oft QAeA;%1C11 TImP Mnv d 4010 11-UAM Mn 7001 NOV. 7.2019 2:07PM DCI IOWA IOWA CRIMINAL 1116TORY DCI 00402693 MISDEMEANOR CONVICTIONS ONLY PAGE I OF 3 DATE PRINTED- ' 2019/11/07 DCI:00402693 NAME: VANDEMARK,DANIEL JOSEPH DOB SEX RAC HGT WGT EYE BAIR SFN POB 19550723 M W 600 170 BLU ERO FAR CO ADDITIONAL IDENTIFIERS TAT R ARM TAT R SHLD DISP EFF DAT 19900629 19900829 19900629 19900829 19900829 TRK#: 030611802 CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19900317 AGENCY: IA0080100 BOONE PD CHARGE NO- 01 IA STATUTE IA321J-2 Oerl SUSPENDED JAIL TRK#: L37665101 19970702 COURT DISPOSITION 48H AGENCY: IA008015J BOONE CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WE INT OWI SURCHARGE CHARGE CLASS: MISDEMEANOR CONVICTION ' TRK#: L37685101 SUBSTANCE ABUSE EVALUATION SENTENCE 2Y PLEAD GUILTY FINE $500 SURCHARGE COURT COSTS PROBATION lY SUSPENDED 30D 02 ARRESTED/TAKEN INTO CUSTODY 19970325 AGENCY: XA0940000 WEBSTER CO SO CHARGE NO- 02 IA STATUTE IA321J-2 OWI 1ST OFFENSE TRK#: 030611802 COURT DISPOSITION AGENCY: IA094015J WEBSTER CO DIST COURT COUNT NO- 02 ZA STATUTE: IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION DISP EFF DAT 19900629 19900829 19900629 19900829 19900829 TRK#: 030611802 SENTENCE DISP EFF DAT PLEAD GUILTY 19970702 SUSPENDED JAIL 5M 28D 19970702 JAIL 48H 19970702 FINE $500 19970702 SURCHARGE COURT COSTS 19970702 PROBATION 2Y 19970702 No.7634 P. 2 Nov. 7.2019 2:08PM OCI IOWA DCI 00402693 PAGE 2 OF 3 No. 7634 P. 3 03 ARRESTED/TAKEN INTO CUSTODY 20000929 AGENCY: IA0940000 WEBSTER CO SO CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESS CONTROLLED SUBSTANCE/MARIJUANA TRK#: 039962701 COURT DiOPOsiTION AGENCY: IA094015J WEBSTER CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 039962701 SENTENCE DISP EFF DAT COURT COSTS 20010411 SUSPENDED 10D 20010411 04 ARRESTED/TAKEN INTO CUSTODY 20050420 AGENCY: IA0400000 HAMILTON CO SO CHARGE NO- 01 IA STATUTE IA124.401-5 POSSESSION OF MARIJUANA TRK#: 064628701 COURT DISPOSITION AGENCY: IA040015J HAMILTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.402(1)(E; POSE CONTR SUBS,KEEP OR PERDaT USE IN STRUCTURE OR VES COURT CASE ID: 02401 AGCRO11430 CHARGE CLASS: MISDEMEANOR CONVICTION TRX#: 064828701 LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 2D 20050601 FINE $500 20050601 An arrest without disposition is not an indication of guilt. This record maintained by the Iowa Division Of Criminal Investigation, Bureau Of Identification is a public record but can only be released to non -law enforcement agencies by the DCI, Nov. 7.2019 2:08PM DCI IOWA No.7634 P. 4 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). Addir,innnily, nriminal history Rata concerning convictions fnr certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http;//www.iowaeexoffender.com/ . However, even though some information is available on this site, the actual records fox juveniles may still be confidential and any confidential juvenile records cannot a proviclecl 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(19). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED,!WE CANNOT CONFIRM OR DENY THAT THE RECORD LI ^' COVERS THE SUBJECT OF YOUR INQUIRY - DIVISION DIVISION OF CRIMINAL INVESTIGATION CJI DDT - vipww.iowadot.gov S1.1,ARTER I SIMPLER I CUSTOMER DRIVEN onvei $ Idi itwcatlon sorvreas PO Sox 9203 i Des trbinm IA 69306-92N Pn9ne' 515244-91741 Fax 5157.+9-1837 Certified Abstract of Driving Record Inquiry Date: 11/4/2019 DL/ID #: 182CC7420(IA) Customer #: 1328375 Name: Vandemark, Daniel Class: C ID Status: None Joseph Address: 1904 Sunset St Audit #: 3196780 DL Status: VAL Issue Date: 09/14/2018 CDL Status: None City/State: Grinnell, IA Expiration Date: 07/23/2020 CDL Cert Status: None 501121047 Endorsements: NONE CDL Med Status: None Mailing Address: 1904 Sunset St Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 07/23/1955 Mailing Grinnell, IA Sex: M City/State: 501121047 History Information Convictions Citation Date Conviction Date ACD Explanation lCounty JUR 07/17/2019 07/19/2019 Improper Registration Hamilton IA Name: Vandemark, Daniel Joseph DL/ID: 182CC7420 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: 11/4/2019 nri,,.r A irinntifiratinn rpr irpc