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Home My WebLink About15-010t `III p - Al 11 CITY OF IOWA CITY Authorization Number"i '�C" ; _ (Office Use Only) APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday.) 410 East Washington Street Iowa City. Iowa 52240-1826 don will result In !Asnial of•ihe alDp9%Gafd®n (319) 356-5040 (319) 356-5497 FAX r -TFfjs4 iddle ast / m 1. Name (REQUIRED) f q -- -ice I. C f 2. Mailing Address (REQUIRED) (s �_ D r It j 3. Contact Information (REQUIRED) Email: r 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State Type of offense Where 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? T e of enpe t Where When 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? 0) Type of offense Where When 9. Have �� ervgr applift be an Iowa City taxi dri r usi Brent n me? If yes, please provide the'hgme(s) n �I-oK I AP f DEPARTMENT OF CRIMINAL AVESTIGATION (DCI) REPORT AND STATE CE11'E 71F „ DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF 'E�l ' �jwj' You must apply for an Individual Department of Criminal Investigation Report (form available'upon`Yequest); a �s (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09!2014 _ tq 9c ? ra I hereby certify, that have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number d �� . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license is granted, to comply at es with all of the p ovisions of Title 5, Chapter 2, of the City Code. (Needs to he signed in front or- a Notary Public) f . Signature ofApplican Date --L:) 2--Z) YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERICS OFFICE. Authorized taxi driver names are placed on the city website at Icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) 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 have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Wel"10,W011"m/rELx._rhief ..- Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. "ted 1 . ` L4,11 Signature of City Clerk or designee .� �a /-,�..5 Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update CleikrrAXIDRNBADGEA?PL82014amerded.DOC 09/2014 s Certified Albstimcit of Driving IRecord Inquiry Date: 1/5/2015 DL/ID #: 7230.75451 (IA) customer #: Name: Miceli, Robin Rene Olass: B ID Status, Address: 932 DUCK CREEK Audit #: 8120161 DL Status: 8 Issue Date: 05/31/2014 city/State: IIO2 4A CF7Y, IA Expiration Date: 08/16/2018 0674 Endarsementog Mailing Address: 932 DUCK CREEK Restrictions: DR Date of Birth: IOWA CITY, IA Sex= 522468674 L NONE 8/16/1964 mistolry information 4816766 EXP VAL VAL CDL Cert Status- Non -Excepted Intrastate CIDIL Med Status; None Restriction None Supplements givenAccidents - Accident involvement indicated does NOT mean the individual was at fault or a citation. Pursuant to Iowa Code 9321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department ofTransportation, do hereby certify that I am the custodian of the records held by the Office of Driver 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 DepafCrjlient of Transportation to so certify. , In witness whereof, I have caused my signature and the seal of the Department In be set upon this dooyment ,*, AnkenyQ Iowa this date: 1/5/2015 I \ ^ > y. 0 1"'.lz Office of Driver ServicesTran Iowa Department of sporation Namm Micell, Robin Rene DH./»723e 07®6Jan, 7. 2015$ 4:04PMCab ,Div of Criminal Investigation UUJan, 6e 20152 ?:HA cob Div of Criminal IAVQ&t lilt l6n C STATH � (XfllIOWA II Criminal I Request Form � � � � ''1 Record�11�� 4..:::. F a 64 IS 111 0.0 IMP :'GT... -X f r C W (FAX)31933627N0' 8321 (FAxplo o® 7370 M ®_ B J04rah of ter ' da d dw of l to r v®xio e No XOWR Cri LORI H11107 Itcoarillt CI IOWA CrImIfild HIMOKY®r 4it o o II O Mw= C 0 Received Time Jan. 7. 2015 2:45PM No.8315 0 0 0 o1JcJan. 1. 201511 4:04P 6b cDiv of Criminal Investigation STATE OF IOWA Criminal History Record CheckRequestForin To. Iowa Division orcrimlool Involflitfiflon support i moor 215 2.7" SIMMI 0.0 1pinut ]own 30319 (ills) fie -dodo (515) MAID Fax (FAX)31933637LNn.8321 P-..20/003 Y, ; w ,ab of Iowa 2 xavro City, M 52244 (319) 338-9771 Fox, (319) 339-730 As of ` a search oli o provided name end date of birth revealad No lowst Criminal History Record found with DCI w Iowa Criminal Motary Record attachad, I3CI � � gt f n SCI iniNale �°�' Received Time Jan. 1. 2015 2:45PM No.8315 Jan, 1. 2015 4:05PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DOI oo250336 DATE PRINTED - 2016101107 DCIIO0250336 NAME; HARaROBIN RgISSHR,ROSIN RRIS Ro BIN RENS 1ty.Ox3R'R9O9DA R00ERoR IN ROGERSa ROSIN ROGERSISOB114 RNNR HAIR 89H POS BEI PAC BET WGT EYE DOBS BR0 LOT WV 19640016 P W 506 155 AODITIONAL IDENTIFIERS SC Lp ARM SC R HND SC RF ARM TAT L RHO TAT R ARM CCS RECORD w+a 01 ARRESTED 19660131 SIOUX CITY PD AGENCY. IA0970100 IA STATUTE 116321-201 CHARGE NO' 01 OWI TRK#: L11002001 COURT DISPOSITION W DTATRY CO DISTE COURT AGENCY: IA097019J IA STA IA321- 201 COUNT NO- 01 Owl MISDR OR CONVICTION CHARGE CLASS, TRK: L17002002- D'AWK DRIVING SCILCOL DI$P SFF DAT SENTENCE 1.99605%3 PLEAD OUILTY 19860013 PROBATION 1Y 19860513 C014ITY SERVICE sox 19060513 SUSPENDED 60D 02 ARRMOTXD 19991015 SIOUX CITY RD AGENCY: %A0970100 IA STATUTE IA321J'2 CHARGE No- 02 owl TRK#Y L17002102 COURT DISPOSITION WOODBURY CO DIST COURT BNCY: IA097015J IA STATUTB ZA121J®9 COUNT NO® 01 owl R CLASS: MISDEMEANOR CONVICTION CHARGTRK#: L17002101 DIOR SPP DAT SENTENCE No. 8321 P. 3 Jan, 1. 2015 4:05PM PLEAD GUILTY JAIL FINE COURT COSTS 9 0 1 ' f t4 CHAEOR M 1 THETT 30 L17002201 Div of Criminal Investigation 'DID $063 COURT DISPOSITION COUNTAGENCY: JA097015U IA STATUTE IA714-2 f F T99FT 3RD 4 'CONVICTION CHARGE F..L17002201 04 ABER TED 19930124 AagNeyj 00 CNAR(jg go- 0 owl 006803,501 COURT DISPOSITIOP9 AGENCY c IA097015J 0L4EURY DIST COURT COUNT 90— 01 OPBI CHUM CLASS: MISDEMEANOR CONVICTION TRK#: - 006807.501. DIS&? 277 DAT 19900104 19900104 19900104 M'11 „' � M No. 8321 PLEAD GUILTY 3AIL 301) 19940406 FINE (. COURT* COSTS.0. ,.. SUSPENDED 1, I'll GO INDICATIONIS NOT AN AN ARREST WITHOUT DISPOSITION INVESTIGATION, BUREAU OF ,NED BY THE MAINTA uU t COR :UEOM"Lhx IDENTIFICATION IS A 1 � CEMM AGENCIES '� , 5 D RECORD ' #'� IN THE ABSENCE OF .. ..y 1 . �,IDENTIFICATION"CORD FIRM OR DENY THAT THE WE CANNOT COX fif FUMISHS BASED ON COVERS THE suBjECT OF YOUR 1 M,