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Home My WebLink About20-049( r t CITY OF IOWA CITY 410 East Washington Street Iota City. lotea 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. 20-0C1c1 (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 r 2. Address (REQUIRED) 6Zkj —S. Ar �`LS a Ct'4 rSb bggv)a 3. Contact Information (REQUIRED) Email: 6e.a ILIA. �Q (",.,v,A Cell Phone: 3,091-W1•loY is (All written cot-Amunication sent via email) 4a. Driver's License expiration date (REQUIRED, b. Taxicab Business Name (REQUIRED). Ye -110,., (rn,0b 5. Prior experience in transportation of passengers: /.? vis . )/* //i w co b 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? WWa Type of offense Where When 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? ./a -S Type of offense Where When S ec'i,;Igj D�;4nR-fJ What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty � I. 4/2. 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ab 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) 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 /��/ XY/moi <t issued on /aL4aseexpiring on,11%IAr.a Sr . 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicaDate STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of Notary Public in and for the State of Iowa 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 (j r.) Ll - 24 Sa' ? Signature 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 Office Use Only ().b�y I �2-0 D to CWWAXiDRNWDGEAPPL92B1Bawnded.DDC 04/2018 �•,IOWADOT SMARTER I SIMPLER I CUSTOMER www•iowadot,gov DRIVEN DrW s idwk" n" se vepee PO Box 9244 i Des Aloins& IA 5030&,sQM Phone315-244-9124 I Fax 515-298-1037 Certified Abstract of Driving Record Inquiry Date: 10/19/2020 DL/ID #: 627XX6064 (IA) Customer #: 2375713 Name: Phelps, Gilbert Allan Class: C ID Status: None Address: 2254 S Riverside Or Audit rr: 4717773 DL Status: VAL Trlr 53 Convictions CDL Status: None Issue Date: 06/06/2020 City/State: Iowa City, IA Expiration Date: 05/14/2028 IACD IS92 522465852 None c Endorsements: Motorcycle Mailing Address: 2254 S Riverside Or Restrictions: Corrective Lenses y Trlr 53 Date of Birth: 05/14/1958 Mailing Iowa City, IA Sex: M City/State: 522465852 History Information Convictions CDL Status: None CDL Cert Status: None IUR 108/27/2019 109/18/2019 IACD IS92 CDL Med Status: None c c� Restriction None - Supplement: __ y rig Citation Date Conviction Date Exolanation County IUR 108/27/2019 109/18/2019 IACD IS92 IS ed Johnson u Name: Phelps, Gilbert Allan DL/ID: 627XX6064 Pursuant to Iowa Code §321.10, 1, 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: 10/19/2020 Driver & Identification Services Iowa Department of Transporation Name: Phelps, Gilbert Allan OL/ID: 627XX6064 N N �7 C, �M i m DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confldentlai 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 confidentiai 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://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).