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HomeMy WebLinkAbout21-028IDENTIFICATION NO. 21 - © ZF> 9 l 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) CITY OF IOWA CITY SC PC ?:aC"i.':IO.?!.' a don Willi es Ulf In den M! oT !ii5 a73 IfCa JJt? 410 East Washington Street _ - - � —�_ lotva City. Iowa 52240.1826 - 13191356-5040 Last First Middle 13191 356-5497 FAX 1. Name ;R=QU:R I `�)f r 5C r it 2. Address (--: _:_I :ED) f i 1� ���t�k RV;"tLp 1 F, 52-29 f 3. Contact Information (REQUIRED) Email: 6pee�zl�Q ofCr��C1 MR t I �(OCell Phone: 3t5 5 qlA (p5 t o 4a. Driver's License expiration date (REAL b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pe 6. Have you ever been arrested/ charged with any misdemeanors end/or felonies in this State or elsewhere? he S Type of offense Where When 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? Iy� Type of offense Where When 9. Haveyou fiver applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) t��l 0 0412018 5 What happened to the charge? (Circle one) i„i Convicted Dismissed Deferred Suspended PleadGuiltytither co 7. Have you been arrested/ charged with any traffic offenses in the last five years? 1 V N Type of offense Where When 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? Iy� Type of offense Where When 9. Haveyou fiver applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) t��l 0 0412018 5 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER DEPARTMENT OF CRIMINAL INVESTIGATION (DCQ REPORT AND eTATe 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 h reby Gerdt at I have Issued to me by the Iowa ep ment of Transportatl n valid Drivers license number 07A ) ' issued on I expiring on ( I understand that If I falsely answer any questions in this tion, that this ep Ile tion may be denied. I AT86 that in making this application, I consent to allow agents or emplo of the City of Iowa City, Iowa, In their discretion, to examine any 'and all records and documents relating to this appile o a d I fu agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of a C ter2 of the City Code, (Needs to be signed I front of a Notary Public) Signature of Applicant Date LI *kYYYIr#Y}*ii**X*XXYYYi*k*i#k*Y**+YYY*YR*IXYYY#XYY*XYM*RY**XMX*hi**Y**X**#**XX*XYMt*Y*iXYi*A*#iirk*XihXX*Xl4X*iiAlYNikiX*IXXXXYXXY*M(*X*Ye*Yii*kXi*i STATE OF IOWA ) COUNTY OF JOHNSON ) Subaodbad and sworn to before me by on this day of I have reviewed this application, DCI report, and the State certified driving record of this applicant And havadeterminacl that there to no Information which would Indicate that the issuance would be detrimental to the safety, health or`Velfare•of real - dents of the City of Iowa Clty (Title B, Chapter 2, City Code), w a m a M Expiration date of Drivers license / l� /2 o �' y rQ 81 re of Police Chief or or designed 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 ddving record Website update rj 2-1 Date �y,WrpXIDRNBA00EAPpL020fAemendedD00 0412018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER DEPARTMENT OF CRIMINAL INVESTIGATION (DCl) 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 t at I have issued to me by the Iowa ep ment of Transportatf n valid Drivels license number 1 �_ issued on 1 i expiring on 9` ¢ I understand that if I falsely answer any questions in this application, that this applfc tion may be denied. I agre that in making this application, 1 consent to allow agents or emplo of the City of Iowa City,r is Iowa, in their discretion, to examine any y and all records tall ion be a cab drive Imes with all relating to this provisions oe a C I f ter2 o9 the City Code. (Neeree that, if tds too be signed n front of a Notary Public) anted, to y Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by on this day of and I have reviewed this application, DCI report, and the State certified driving record of this applicaMhealthve determined tor welfare of eshat there is no information which would indicate that the issuance would be detrimental to the safety, 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 OAUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date Cb,urwooRivaaocsnPae2018amndM.000 0412018 0681'aN WVS1;01 110l 'El'laV eW11 PO"!M STATE OF IOWA ♦1� Criminal History Record Check Request Form DCI Account Number: 9967-F (if rpplicrWe) Mail or Fax cvannleted fo m. Send results to: Iowa Divisiva of Criminal bnvestigation SupporfOperations Bureau, I°° Floor 215 F 7" skeet Dos,Nlvinos, Iowa 60319 - (515) 725-066 (515) 725-60au Fay I am revuesdne an Iowa Cslminal Hiatnry Rae rd Chnrk Aw Name Yolltlw,ab offowa I� 0 CW Address P.O. Box 428—j>- 28;;Iowa � as t r4.,'v��i.'�aad K Sas• fT 19�J t ti Mill.. 1 ■�r 1 IowaCity, loylleft Y_ I llt y • 1S,i �Ir glJil I) P110110 (319)338-471 --�: : Fax 319-3594142 .,,; �g 00 Y wa Criminal Histo a ord Check Results Y ..... As of a search of the provided name and date of birth revealed:` _ LlNo Iowa Criminpi metory Record found with DCI �' IS s � .Q 1 D, . Ma . Iowa Criminal Wnto Record attached DCI # 14 5 G+ 0 • DCI initials. �.. � of DCI -77 (updated 06-26-2018) Pop 1 oft 1, a+l q•l',r(I�"jl � �i�t��u'r�{3:. �.il?� ..'N.&1 .0 +"�E:�ia ail a•� f ..] 1 ' 1 Ir r 1, ..... �1 t r4.,'v��i.'�aad K Sas• fT 19�J t ti Mill.. 1 ■�r 1 aJ Y_ I llt y • 1S,i �Ir glJil I) III ,T�.'ii��'.q�' 1 1 1 1 I I� 1 I�li1 1 �t,�ticw.J1'V\NY� TT^"M�MyJ,� i'I^•�� r t• II''^� �1.� i I.?•�.�T ! I.4� dl .�JLr�.'.r.. t •.Y gatia>�ky„¢ luta �..:.). w� rich:• z t �,: •r..+a'2aur2m.�.rr _—--�s��rr:mwt�ntiasrur Y wa Criminal Histo a ord Check Results Y ..... As of a search of the provided name and date of birth revealed:` _ LlNo Iowa Criminpi metory Record found with DCI �' IS s � .Q 1 D, . Ma . Iowa Criminal Wnto Record attached DCI # 14 5 G+ 0 • DCI initials. �.. � of DCI -77 (updated 06-26-2018) Pop 1 oft IOWA CRIMINAL HISTORY DCI 00456730 MISD9MEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- DCI:00456730 2021/04/14 NAME: DORR,SCOOTER DORR,SCOTT RDWARD SCOOTRR DOB SEX RAC HGT WGT EYE HAIR SKN POB 19630218 M W 600 185 BLU BRO MED GA ADDITIONAL IDENTIFIERS SC L WRIST CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19930328 AGENCY: IA0520200 IOWA CITY PD C) CHARGE NO- 01 IA STATUTE IA236-2A �4 ASSAULT W/INJURY n_<. I f' ---- TRK#: 005989601 'IC-) W 8 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT -C:)r 00 l..✓ COUNT NO- 01 IA STATUTE: IA236-2A 3" N J SIMPLE ASSAULT CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 005989601 SENTENCE DISP EFF DAT FINE $50 19930922 02 ARRESTED/TAKEN INTO CUSTODY 19950210 AGENCY: IADS20100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 014616901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#c 014616901 SENTENCE DISP EFF DAT JAIL 6D 19950217 PAY SURCHG FINE $500 19950217 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 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 RECORD COVERS THE SUBJECT OF YOM INQUIRY. DIVISION OF CRIMINAL INVESTI43ATION CJ n n O a ; N N 1a C0IDWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN NMM!'IOWBCIOt.gOV Drly" a Idsnlifieabon Ssrvicos PO Box 9204 I Des !fames. IA 5030(-9204 Phone 515-211-91241 Fax 51F234-1&97 Certified Abstract of Driving Record Inquiry Date: 4/13/2021 DL/ID #: 407AF8706 (IA) Customer #: 1533865 Name: Dorr, Scott Edward Class: D ID Status: EXP Address: 1749 PARK RIDGE Audit #: 5453523 DL Status: VAL DR Issue Date: 04/13/2021 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 02/18/2028 CDL Cert Status: 1-1 We 522412741 —" Endorsements: Chauffeur 3 CDL Med Status--; he Mailing Address: 1749 PARK RIDGE Restrictions: Corrective Lenses Restriction I -'- Nobe DR Supplements -)- I Date of Birth: 02/18/1963 -; C Gn"� �TI S Mailing CORALVILLE, IA Sex: M City/State: 522412741CO History Information 3`� T%' N Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 107/13/2019 1123320 IA Name: Dorr, Scott Edward DL/ID: 407AF8706 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: pM1,e4 Nt or ,g54s 4/1133//20022111 9, Driver & Identification Services Iowa Department of Transporation Name: Dorr, Scott Edward DL/ID: 407AF8706 Ri -yam ,r �C--) w r dco o N m