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Home My WebLink About20-022CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-SO40 (319) 356-5497 FAX IDENTIFICATION NO. Zb -02- — (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 1. Name (REQUIRED) tt4/ji .-nf C1, yaw 2. Address (REQUIRED) 409' lo4,g f,/p )ry fpwO 3. Contact Information (REQUIRED) Email: Cell Phone: 3/9 "594-Yfgo (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) ar dy 3 { b. Taxicab Business Name (REQUIRED) Ye//vwCvG of ha 5 Gam► 5. Prior experience in transportation of passengers: 6 Vmz r !u /, a/i• ,i 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Na Type of offense Where When rn What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When F"Pl", /iv lve- v///c /y. iti, /t9 r ;y - /f What happened to the charge? (Circle one) 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? /P0 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) y✓ (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 rr 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 1 have issued to me by the Iowa Department of Transportation a valid Driver's license number P550k"VFVy issued on N-IS_/7 expiring on I-44'5 . I 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 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature ofApplica�� Date 3-/1_2o STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Ma,�cc�y. 2-02-y ASHLEY A JAY-PLATZ My Commission Expires on this I11 day of f: - r I have reviewed this application, DCI report, and the State certified driving record of this applicant and haps determined that there is no information which would indicate that the issuance would be detrimental to the safety, health W welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license U `/ — 700 Z T --7 � 7 Z e Signe o 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 GestgA IDRrvaADceAPPLe201ee�Pa DOC 04/2018 ULI fo,ww vi45o } cuvw L8D r •t IrAX)J19aA A,w r.JVJIVVO STATE OF IOWA Criminal History Record Check Request Form Mail or Fax MM fomes to: Iowa Divislou of Criminal Investigation Support'Opemdona Bureau, 14 Floor 215 E. 71, Street DealMlainco,Iowa 50319 (515)725-6066 (515) 725-6080 Fax I am repuestim an Iowa Criminal History Record Cbeck on: DCI Account Number: 9967-F (if vpdmble) Send results to: Name YeWwXob of Iowa Cis Address P.O. Box 428 Iowa City, Iowa $2244 Phone (319)33&9777 Fax 319-359-4142 As of _FEB e 6 2 a search of the provided name I P"o Iowa C1:lmiu l History Record found with ))CII El Iowa Criminal History Record attached, DCI # DCI initials DCI -77 (updated 06-2,640I8) Received Time Feb, 19,`2020 9:47AM No,0724 Results I,,. I J:I O f ''•ir, lj date of birth fe, +paled: °y •ll g _ rLsec'S �e4�.' 0 l - d y-`Zo - Mmale []Female Sit - ,t _ '�i; _, t(i�1'p"ctfif�her��S�F`F"„pee'�"' "e'ei¢t'��►�ii[oryreb9rdmay tiWKli�li j�rfa018a'edbF14VS; �� r� l �.�A ,ir�'x a#i<-,.spry `•ria ,ti kye .,tLr 7rl�'•+! {y�•7TiE w � y �� F' y v7aK 517wcahr!6'ui�Yd..i�ff - bi. tx�� , '�: �F, h},uh0µ�a cc, �.y .ual�ci,`t�ui�kY�15(v!(toA 6fR DO�G'4y �IO�SC i$IWl-1 �D�f13� t.7 �1�w•A�w•r�^�4 �6.'OpD �OtUde r �1 •4 T%. ! ISL �"jj /ice 1 .. 1 it n�f�• T As of _FEB e 6 2 a search of the provided name I P"o Iowa C1:lmiu l History Record found with ))CII El Iowa Criminal History Record attached, DCI # DCI initials DCI -77 (updated 06-2,640I8) Received Time Feb, 19,`2020 9:47AM No,0724 Results I,,. I J:I O f ''•ir, lj date of birth fe, +paled: °y g _ rLsec'S �e4�.' In Page 1 of 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: h".-Ilwww.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), N C') P.) C-. _ =�c7 — �r M n. CD T �, 1 't / On 1GWA00T i do clj SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov DrWw 9 WorAilfeatioa S4m"Vil 4 PO Box 92041 Des Manes. IA 503069204 Pl0ne: 515-244-9124 1 Fax 513299-1837 Certified Abstract of Driving Record Inquiry Date: 2/19/2020 DL/ID #: 255DD4944 (IA) Customer #: 4329777 Name: Williams, Clifford Class: D ID Status: None Steven Address: 1015 W BENTON ST Audit #: 1752853 DL Status: VAL APT 45 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. _ Accident Date Case Number Issue Date: 04/18/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/04/2025 CDL Cert Status: None 522465116 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1015 W BENTON ST Restrictions: Corrective Lenses Restriction None APT 45 Supplement: Date of Birth: 01/04/1980 Mailing IOWA CITY, IA Sex: M City/State: 522465116 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. _ Accident Date Case Number JUR - 01 24/2019 1094341 IA Name: Williams, Clifford Steven DL/ID: 255DD4944 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: OIL Name: Williams, Clifford Steven DL/ID: 255DD4944 2/19/2020 o�Gti� sOcsf-�. Cl Driver & Identification Services Iowa Department of Transporation N [7 N �J r "" ut N,