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Home My WebLink About15-0061 i Y CITY OF IOWA CITY 410 East Washington Street lotva City, lots 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authoft-ation Number_ (Office I ° s APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) falluM to ccPvrp eip flee "re u6red"_snfiaaevaatdces Arc'Ad, reEatdt ePP aaP sraa6 Psithea Odcafioer 1. Name (REQUIRED) FM 2. Mailing Address (REQI..IIIZED) Last 3. Contact Information (REQUIRED) Email: � � w°trt� a l �... I& au �Z �'5 t4,, A &m Cell Phone: 4. Prior experience in transportation of passengers: L 4-,( Ld,la- r }i P a L at �vll 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 0 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide tWdbme(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVJFW You must apply for an Individual Department of Criminal Investigation Report (form avallable:upo"., quest).' (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereby certify that I haveissued to me by the Iowa Department of Transportation a valid Chauffeur's license number S 5�j ',,ie/ `� . 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 all times with all of the provisions of Title 5, Chapter 2, of the City Code. (weeds to be signad in front of a Notary public) ., Signature ofApplicarYt"��";� ' ... ` . ".°�"Date 1 �y 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by.. ria ° •. " ;eah,ut r "/, On this rFik vi 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). thie or designee 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. - CA, Signa re of City Clerk or designee .. Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %1' (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update C!e�WiAXIDRIVBAJGEAPPL92014emaMed.000 092014 ISTA IE OF IOWA d (a a & -. _... - Request Forrii uw: DMilrut of CrInninal Invatl9ation SupportOperations oo 215 & 71, Streat liOV MA161) IOWA 60319 (615) 7294066 126-6080 Utecic on. evkder ME hNa.7280 fP. X1/1 JjV1 DOIAccountNuut6ar:,__._. From �Ieyoa9fmwva qN� city Clew@ Ofblere dyo.k. "'nahington Strook 1YoaveaCBE.%..:TA 992240 Phone: 3iy-3dd,.,0dl.raw 11-9-366-90, 2"hwRFt$I'Owa. Without a ,4ases wliverfrom this su blest of the irequo44 a eaorro joto orefiou W WINory record may not �reb« uf�da otrul�+ap d `.hrsputeu° ��.2,0:N?uax �crr�n, J ct a;rlusxluusal.Pau'at®xy b°ecerd Nuado`mmbnN(onA as iNVfonur�ad lolr Rawv� ua1wV'ayg Wahet Relemfe!Ihm6ygivepannlsslon for the aboVcragvesdngofficial(o aonduaeae lowacriminalhistosyrccord CheckallhihdDivlslonofCtlminel Inmilptlon (DCI), Anycrinrfnsl hlslory dila cehcros'ngue dist is mainlainadbylhe DCrmay horefcasad as allosvad by larv, s Io I nal. i P Record Che ck:> srnl(DChlraCmy). . As of �.... a moroh oft'ibo ,(ro°w.6.ded name andf. date of birth nra'we riled . i No Iowa Criminal IlisWq Reoud found With DCT IowaCdrainalHistory Record attached, DOT9 .. .......................... .; Received Time—Jan. 2.-2015—I1MAIV16�7236 Jan. 5. 2015 9:37AM Div of Criminal Investigation u vuu: um 4, LV IJ II•V 4"". V.lr VI%IA V16r VI IVnn VI k ISTA IE OF IOWA d (a a & -. _... - Request Forrii uw: DMilrut of CrInninal Invatl9ation SupportOperations oo 215 & 71, Streat liOV MA161) IOWA 60319 (615) 7294066 126-6080 Utecic on. evkder ME hNa.7280 fP. X1/1 JjV1 DOIAccountNuut6ar:,__._. From �Ieyoa9fmwva qN� city Clew@ Ofblere dyo.k. "'nahington Strook 1YoaveaCBE.%..:TA 992240 Phone: 3iy-3dd,.,0dl.raw 11-9-366-90, 2"hwRFt$I'Owa. Without a ,4ases wliverfrom this su blest of the irequo44 a eaorro joto orefiou W WINory record may not �reb« uf�da otrul�+ap d `.hrsputeu° ��.2,0:N?uax �crr�n, J ct a;rlusxluusal.Pau'at®xy b°ecerd Nuado`mmbnN(onA as iNVfonur�ad lolr Rawv� ua1wV'ayg Wahet Relemfe!Ihm6ygivepannlsslon for the aboVcragvesdngofficial(o aonduaeae lowacriminalhistosyrccord CheckallhihdDivlslonofCtlminel Inmilptlon (DCI), Anycrinrfnsl hlslory dila cehcros'ngue dist is mainlainadbylhe DCrmay horefcasad as allosvad by larv, s Io I nal. i P Record Che ck:> srnl(DChlraCmy). . As of �.... a moroh oft'ibo ,(ro°w.6.ded name andf. date of birth nra'we riled . i No Iowa Criminal IlisWq Reoud found With DCT IowaCdrainalHistory Record attached, DOT9 .. .......................... .; Received Time—Jan. 2.-2015—I1MAIV16�7236 f Cem-ti,ned Abstract of Diving 114ecord Inquiry D&tra: 1/2/2015 DN./ID •a: 554XX1775 (IA) Custowner gid: 23794$62 Name. Ramirez, Margeaux Class 0 ITIS Status. None Rose Addrew 211S Audit 6009045 DUStaflusu VAi.. WESTMINSTER ST "sue Dabo. 05/29/2012 CI LStabuw VAL City/ to: IOWA CnY, IA ft0ration Daft; 03/11/2015 CDC. Cert atur.. 5tcepted :Intrastate 522454942 EndorsernentsN INS CDN. Merl taus: None Malan Address. 211 S IRestrictaorrm Corrective Lenses Restriction None WESTMINSTER ST Supppenenu Data of NurtN: 3/11/1963 Mallin IOWA CnY, IA sw F' City/ ate: 522454942 II 1sto • ;Itnforma'tion Accidents fault or given Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, 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 Departfri¢tdt of Transportation to so certify. In witness whereat I have caused arty signature and the seal of the Department to be set upon this document, at AAkany, Iowa this date: v cA, qpw c-A,:oirmx-j4, Maimm IWammiiu'm„'Nairg'gnao m( IpkdmPse Ud"I16°A'a 5.54XXI.775