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Home My WebLink About20-051IDENTIFICATION NO. 20- 05 1 l 1 (Office Use Only) APPLICATION FOR TAXICAB I 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 Cite. Iowa S2240.1826 13 19) 356.5040 Last First Middle (319) 3S6.5497 FAX /�� a,,,_ *;4_ �tLNscQ.� 1. Name (REQUIRED) l 2. Address (REQUIRED) 3-701 21461 S� #Z7 Cor41V.'(f�, i4 3. Contact Information (REQUIRED) Email: yc�w`6le�atrr �9t«a J- `o4 -Cell Phone: :�l F-67 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) q- 3 - 2 G Z5 b. Taxicab Business Name (REQUIRED) Hgl(pk> CLLO BT d otu� G( 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? Tybeofoffense Where When _ 1 ub u� i z a0 -7-1- Z a La all 11 To•c).t r - ZOls( What happened to the char ircle one) Convlc a 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 � ✓wo2:,t Z_cLo L4 What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license ulfeur's license been suspended or revoked in the last five years? 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) vQ/L' (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 7G5 i /Z 1 issued on /u-9-2«('expiring on nY e3- Za's". 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 itle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date /(, Z 7 Z 1HRiH111f f fH1HfYff lfff YIIHHYYffflflHflf INff ifhkf1f111Hf}fifkll}}YfflfYYflfYf}HfflfiltflHH11H11111M1ff 11ff11Hf1Hf11111HH}}}1fN STATE OF IOWA ) COUNTY OF JOHNSON Subscribed and sworn to before on this day of f111IrYlYYMNiHiNMN{rNYfRffNM1f44MNNNNANN111 NfNNYtMINNYfNNY11fYNNi,YMNNMN1IINfYNNMINN1Y1fifN1Y}NYNfY1iM111NN 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 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 DOTE LISTED BELOW. -1? In Date Office Use Only Approved application DCI report State certified driving record Website update CbMrAX1DRIV9ADGEAPPL82018amm,ded.DOC 0412018 I .Lil •1.`sr IOWA CRIMINAL HISTORY DCT 00626884 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2020/10/26 DCI:00626BB4 NAME: WOODS,JUSTIN MICHAEL DOB SEX RAC HGT WGT EYE HAIR SKN POE 19820403 M W 507 110 GRN BLK FAR IA ADDITIONAL IDENTIFIERS DRUNK DRIVING SCHOOL CCH RECORD 01 ARRESTED/TAKEN INTO CUSTODY 20000813 AGENCY: IAD310000 DUBUQUE CO SO CHARGE NO- 01 IA STATUTE IA321J-2 owl FINE $1000 TRK#: 0537BO401 PROBATION 2Y COURT DISPOSITION SUSPENDED 90D AGENCY! IA031015J DUBUQUE CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI CHARGE CLASS! MISDEMEANOR CONVICTION TRK#: 053788401 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 2D 20010411 FINE $1000 20010411 PROBATION 2Y 20010411 P SUSPENDED 90D 20010411 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://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 record®, 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 RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION C410WADOTwww.iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN DfW 61d1nrkawn a11v1c�s po Box 92011 Des Moines. IA 50306920/ Phone 515.244.91241 FaX 51523&1837 Certified Abstract of Driving Record Inquiry Date: 10/28/2020 DL/ID A: 705XX9421 (IA) Customer ax: 1409870 Name: Woods, Justin Class: C ID Status: EXP Michael Address: 3701 2nd St Trlr 27 Audit p: 5029083 DL Status: VAL Issue Date: 10/09/2020 CDL Status: None City/State: Coralville A Expiration Date: 04/03/2025 CDL Cert Status: None 5224132l7 Endorsements: Motorcycle CDL Med Status: None Mailing Address: PO BOX 5264 Restrictions: NONE Suppiction None Supplement: Date of Birth: 04/03/1982 Mailing CORALVILLE, IA Sex: M City/State: 522410264 History Information Convictions Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Woods, Justin Michael DL/ID: 705XX9421 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: 10/28/2020 Name: Woods, Justin Michael DL/ID: 705XX9421 Driver & Identification Services Iowa Department of TranSpOration