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Home My WebLink About19-0881 r i CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. I 1- 0800 (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 11 First Middle jLkS ,)Gt101 yA.Ic C:4- A r 4. 7- 3. 3. Contact Information (REQUIRED) Email: i,&3 "10-w% ( LS�o— Gj� ai I - ("M Cell Phone: C3l°1) 436- Zd'q� (AII written communication sent via email) 4a. Drivers License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 2.qo JJ5816 :.►1��., Cup a I��..t~ L, 5. Prior experience in transportation of passengers: r✓ i I Y &y l As o Ch h Ur(JC/, of - AI, J j./wez Mhrw'J IN :; 6. Have you ever been arrested / charged With any misdemeanors and/or felonies in this State or elsewhere? %I Type ofoffense / Where When CriA �ti� N\;Sci,ief iji1 �ejle( Jo�4113e C014X 0 Ul-;-FI PnIiO.4 Sri 8f'1rcc J�I^N,n ia, \0 21 � o? \f4erk1er-Li' �J/ r0l�ic"hl tiu:I J.\11AS �� nl1 12/07/ 0-7A/resie� / aetetlea t-�N Cj-nlr i/Ik /lo P ossers; �� -,k See to What happened to the charge? (Circle one) Convicted Dismissed eferr Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? ye S Type of offense Where When S�Ce 30�IAJ�� Coy,4 112,1 16 \,or -r P1- JQL1/1,Q,\ cai� %j tl /Zct/ 16 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Type of offense When 9. Have you ever' applied to be an Iowa City taxi driver using)f� tlfR pt name? if yes, please provide the name(s) jnwa City. Iowa (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0412018 � 6 C04 4;,. ee , TyP� o F otters C(iMlnnl M;sc�i� tii� �rce "'14y a6s4roc417 ct Peace.. o{icef 6�4;I4-/ Co"S.,,f. ; c'l / jn-i-o-/i cc, �;., , 6 H i 147 IA4Cji?lenc2 u/I a�t;ci�� ne�s� Gu`�'J $od; l7 (Aj �le�ol;� lcd /VoI w� Jct4nl9�\ [.ohnly jo�IAJun CO.Ot 11 t�e��l;ti le1d �11 o I Ind r /eI%ce ul o if«(yl torr 6-%'14y r tjo :I,k4 Joh Joy,I'S 9� Crl�1� J, Innsol Co"1�4/ J' COnn4Y J,,'i DA of Jt, t JGkWl A Co�ndr w�-" F/2-1/03 LF/o/o`I q1 7 /D7 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 Investigatio Report (form available upon request). /_ _ �',i�'Z/I�l �z/12/1q �w !4� i�� I "£' 5k'j H I hereby certify that I have issued to me by the Iowa De artent of Transportation a valid Driver's license number ZN ° J 5 16 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, H authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Ch Ater 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant —< Date t 1 2 0 61 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by _�C- S ° r y a �� Hi �k 5 on this 2a day of t�o� 2Cr� ASHLEYAJAY-PLATZ $Zt Commission No. 785030 otary Public ' a e S of to mm rover July 14, 2020 I have reviewed this application, DCI report, and the State certified driving record of this applicant pplicant 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 Drives lice 07'11" 670ZI Sign5turd-of 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. Approved application DCI report State certified driving record Website update NOV 2 0 7019 City Clerk Iowa City. Iowa 1(-20-1q Date Gew✓rn IMWanocenvaigMlU—a -MC 04/2018 1 STATE OF IOWA Criminal History Record Check Request Form DC1 Account Numor, 99d� (ifo�psc-ic�c) Mail orPax letedforma to: Scnd resins te• Iowa Division of Criminal Investigation Name Yellow Cah ar Town City Support Operations Bureau, III Floor 215 E. 7m Street Address P.O. Box 428 Dee Moines, Iowa $0319 (515) 725-6066 Iowa City, Iowa 82244 (515) 725-6080 Fax I am requesting an HTr- k5. I 30�so^ 71 1 6f /-7 3 1 isle As of `\' �Iz k� a search of the provided name No Iowa C4 =01 History Record found whh' Io R,a Crimiml Hist0ryReoord•attac)MH1(,bHi DCI DCI -77 (updated 06.26-2018) Received Time Nov. 11, 2019 1:32PM No. 7860 Phone(319)338-9777 Fax 319.359 4111 �' \/a. )�P— �mot. 1� 3" o z " CI -/ L -K icy Clerk Tlty IOWA �s Iowa criminal i history results. :. DIV e t6 0 (==a*) OF IOWAJDPS 12 2019 CRIMINAL INVEST Paso I oft IOWA CRIMINAL HISTORY DCI 00705854 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2019/11/18 DCI:00705854 NAME: HICKS,JASON YALE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19730719 M W S10 150 HA2 BRO PA ADDITIONAL IDENTIFIERS PBOTO AVAILABLE: Y CCH RECORD "'w annRRTCn /TLYtdNf rmmn r4icmnny IAAlAO09 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA716-6 CRIMINAL MISCHIEF 4TH DEGREE TRK#: 100939301 'COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA716.6(2) CRIMINAL MISCHIEF 5TH DEGREE COURT CAS$ ID: 06521 SRCR066291 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100939301 RESTITUTION SENTENCE DISP EFF DAT FINE $50 20031021 02 ARRESTED/TAKEN INTO CUSTODY 20070907 AGENCY: IA0520200 IONA CITY PD CHARGE NO- 01 IA STATUTE IA719.1(1)B INTERFERENCE W/OFFICIAL ACTS BODILY INJURY TRK#: 1A002AH01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA719.1(1)B INTERFERENCE W/OFFICIAL ACTS, BODILY INJURY COURT CASE ID: 06521 AGCRDS0742 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: lAO02AH01 SENTENCE DISP EFF DAT JAIL 51) 20071207 FINE $625 20071207 03 ARRESTED/TAKEN INTO CUSTODY 20100419 IIIA AGENCYCHARGE: FILED HAR E.NO- 010200 STATUTED IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: IA0096TOI Nov 2 COURT DISPOSITION City Clerk AGENCY: IA052015J JOHNSON CO DIST COURT Iowa City, Iowa COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRO90556 DCT 00705854 PACE 2 OF 2 CHARGE CLASS: NON CONVICTION TXX#: 1A0096T01 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20100915 PROBATION lY 20100915 DISCHARGED PROM 20110513 DEFERRED JUDGEMENT 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. 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-(Jwww.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 juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFI BASED ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR COVERS THE SUBJECT OF YOUR INQUIRY DIVISION OF CRIMINAL INVESTIGATION FILED acv 2 0 HIR City Clerk Iowa City, Iowa L210WADOT wwwiowadot.gov SMARTER 1 SIMPLER I CUSTOMER DRIVEN Driver d kfemifIcatbn servloes PO Boa 9204 1 Des Moines. IA 503069204 Phone 515244-91241 Fax 515.239-1937 Certified Abstract of Driving Record Inquiry Date: 11/12/2019 DL/ID #: 290JI5816 (IA) COL Permit Class: None Customer •: 3968765 Class: D CDL Permit Issue None 12/05/2016 Improper Registration IA Washington Date: 112/05/2016 Name: Hicks, Jason Yale Audit #: 1327395 Col Permit None Expiration Date: Address: 640 Stuart Ct Apt 2 Issue Date: 09/27/2016 CDL Permit None Endorsements: Expiration 07/19/2021 CDL Permit None Date: Restrictions: City/State: Iowa City, IA 522453535 Endorsements: Chauffeur 3 ID Status: None Mailing 640 Stuart Ct Apt 2 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing Iowa City, IA 522453535 Supplement: CDL Permit Status: ELG City/State: Date of 7/19/1973 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions :nation Date Conviction Date ACD Explanation JUR County 10/15/2011 01/19/2012 S92 Speed IA Johnson 11/29/2016 12/05/2016 Improper Registration IA Washington 11/29/2016 112/05/2016 S92 Speed (10 mph & under in 35-55 mph zone) IA !Washington Name: Hicks, Jason Yale DL/ID: 290JJ5816 (IA) Pursuant to Iowa Code 4321.10, 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: �xr or av` rnr ' 11/12/2019 O�or4i 0000�e% Driver & Identification Servlces Iowa Department of Transport4tlppF' e E D Name: Hicks, Jason Yale DL/ID: 29005816 (IA) W 2 0 2019 City Clerk Iowa City, Iowa