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Home My WebLink About19-091®94 ORrt.Y.._ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. 1 CA' 09 1 (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 resuk in denial of the apolication Last First Middle J. Contact Intormatlon (REQUIRED) Email: f4 3 cS54J 6e+a. Cell Phone: "J4 Neo 95B'4 ( itten communication sent via email) 4a. Drivers License expiration date (REQUIRED) -4 t6 "9.5m> O 81 a3 Igo; y b. Taxicab Business Name (REQUIRED) 7Ctlar C�b eF Cta 5. Prior experience in transportation of passengers: r c..ocrul wrl+� 1/ern..a C -b } u c r-� C.wn 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or ejsQwhere? les Tvce of offense Where =roo- r , When — ftit3 0101'. 71rcd What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Gui Other Have you been arrested I charged with any traffic offenses in the last five years? Ob Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? Na Tvce 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 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 itteXX93$9 issued on o6/o9/8oAexpiring on 1 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of�pNotary Public) Signature of Applicant 1 Date If -d"3- 94�01` z o � STATE OF IOWA ) COUNTY OF JOHNSON ) pSubscribed and sworn to before me by �T>c ` on this 2S�`` day of rWet ASHLEY A JAY-PLATZ $ Commission No. 785030 Notary Public in a Stated lea expli July 14, 2020 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 ligame Signature of Police Chief or designee Gb Z 3 z,4 l� ZS"-lF 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 Gees MIDRrvenocEAPPLasolU.n a DDC 04/2018 4OIz812019 13:04 Yellow Cab (FAM9338 2708 P.0031003 STATE OF IOWA Criminal History Record Check Request Form ACI Account Number: 9967-F (if owlimbk) Mail. or Fax oomvletad forms to; Send results to:. Iowa Division of Criminal Investigation Support Operations Bureau, V Floor 215 E. 74 Street Des Moines, Iowa .50319 (515) 7I5-6066 (525) 725.4080 rax I am requesting an Iowa Criminal Mstor yRecord Check on: Name Yellow Cab of Iowa City Address P.O. Box 428 Iowa City, Iowa 52244" Phone 5319)336-9777 - > I; Fax 319-359AI42 Laslsriae. o(�t Bio C:!.. As of a se=b of the provided nems tuid,date of birth revealed �� G Ibis* _-bt 1 C:) c-, m O C) _ an) — \485 09011e IFemale (dt'q rJ..blyk"" y9 fi.ssaCgnPs4Sio'mPi� �. ti(n44 i}n►atyortaaralTosied issJi sil."C we i "y.I'.�..�i,t •>X}. f �.iQ- r 'C.�pR m '�. 44AbQ�� 'W 00-t ��Z'6, 6;;"O x .. t. Y"!• z�: h� ^Y^^.uuYO. Y i' RlP> J .Y �-r"/�.r. wx...Wy/ �, �,�, �!'1�•xS � .r �� .,a ,�,rw: �.�y,s� I ,�A\ r I;t'' 17,S a..... 1 r.. k+..v:.. ..f Iowa Criminal ahigrXRecord Cheek-Aisults o(�t Bio C:!.. As of a se=b of the provided nems tuid,date of birth revealed �� G N _-bt 1 C:) c-, m O 6 Iowa Crb—m-u2l History MEW o wtt } o0 • Tows Criminal History Acord attarced DCT # ''•e : %" ` •``\` m Q DCI initials l (� ry/�IBlll 111111�1111\\•\l1\\' u°i DCI -77 (updated 06-26-2018) n...�_.i T:_. n.i 10 9n1n 1I.CAM ti. coir Patio 1 of 2 IOWA CRIMINAL HISTORY DCS 00975321 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2019/11/01 DCI:00975321 NAME: JONES,BRYAN DEAN DOH SEX RAC HGT WGT EYE HAIR SKN POE 19050823 M W 506 140 BLU BLN PAR IA ADDITIONAL IDENTIFIERS TAT RACK TAT CHEST TAT L SHLO TAT R ARM TAT R SHLD PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20130215 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEE WH INT (OWI) / IST OFF TRK#: IA00GSR01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(2)(A) OPERATING WHILE UNDER THE INFLUENCE 13T OFFENSE COURT CASE ID: 06521 OWCRIO0878 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: lAO0G5R01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 2D 20130515 FINE $1250 20130515 02 ARRESTED/TAKEN INTO CUSTODY 20130509 AGENCY: IADS20100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J,21 DRIVING WHILE LICENSE DENIED OR REVOKED TRK#: 1A00GOL01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.21 DRIVING WHILE LICENSE DENIED OR REVOKED COURT CASE ID: 06521 SRCR101695 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: lAO0GOL01 SENTENCE DISP EFF DAT FINE $1000 20130826 N O C� `n ^z- C^7 n < n f IV cn ! � r rn � Ui J 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. Tine 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 an the Iowa Sex Offender Registry: http://www.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 IDENTIFICATION THIS RECORD -IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECOI�� COVERS THE SUBJECT OF YOUR INQUIRY. Ty DIVISION OF CRIMINAL INVESTIGATION _n"< -{C7 �r - rn o� D N 0 /P �410WA DOT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Drw" 8 IdxMYfesdon sarviers PO eox 9804 I Des Maines, IA 50306-9M Mr" 515-244-9124 1 Fax 516-29& 1837 Certified Abstract of Driving Record Inquiry Date: 10/28/2019 DL/ID #: Name: Jones, Bryan Dean Class: Address: 429 UPLAND AVE Audit #: DL Status:''- VA= Issue Date: City/State: IOWA CITY, IA Expiration Date: 3 522455246 CDL Cert stat NoN 05/09/2013 08/26/2013 Endorsements: Mailing Address: 429 UPLAND AVE Restrictions: CDL Med Status: IT; NofR ST�1 Date of Birth: Mailing IOWA CITY, IA Sex: City/State: 522455246 No" Convictions 716XX9388 (IA) Customer #: 4132943 Explanation C ID Status: 0 _ VAS 05/15/2013 4049826 DL Status:''- VA= IA 08/02/2019 CDL Status: CD ✓ None 3 08/23/2024 CDL Cert stat NoN 05/09/2013 08/26/2013 B20 Driving While Johnson Motorcycle CDL Med Status: IT; NofR ST�1 IA Suspended, Denied, `_�'—t, `--% Corrective Lenses Restriction No" Cancelled Revoked Supplement: - •• 08/23/1985 Denied, cs A History Information Citation Date Conviction Date ACD Explanation County JUR 02/15/2013 05/15/2013 A20 Operating While Johnson IA JUR Revoked Intoxicated 08/25/2013 A98 05/09/2013 08/26/2013 B20 Driving While Johnson IA B25 Driving While IA Suspended, Denied, Suspended, Cancelled Revoked Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD I Explanation JUR lCounty 102/15/2013 A98 I OWI Test Failure IA Johnson Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 02/27/2013 08/25/2013 A98 OWI Test Failure IA IA Revoked 10/09/2013 04/06/2014 B25 Driving While IA IA Suspended, Denied, Cancelled, Revoked Suspended 10/24/2013 08/01/2017 D53 Non-Paymentof IA IA Suspended 02/06/2014 06/24/2017 D53 Non -Payment of IA IA Iowa Fine Name: Jones, Bryan Dean DL/ID: 716XX9388 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: O�p4P��£~T Oc Tgingeol 9 _O = Name: Jones, Bryan Dean DL/ID: 716XX9388 10/28/2019 Driver & Identification Services Iowa Department of Transporation ci g2i C -J �r M ED N O ..o O C N Cil