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HomeMy WebLinkAbout15-077.1 r 1 so CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. 1 -r, -C7 J (Office Use Only) APPLICATION FOR TAXICAB 1 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 First 1. Name(REQUIRED) GI/ 0b 2. Address (REQUIRED) � d 62 3. Contact Information (REQUIRED) Email morlot7 (All written com Middle on sent vi/a/ Last Phone: '/ 3 r - C. 4a. Chauffeur's License expiration date (REQUIRED) V / " G1 7 O b. Taxicab Business Name (REQUIRED) Ped L n L. W 5. Prior experience in transportation of passengers: I CAPR 0 2015 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? ,e i Where tlf v A')n When 3- 2L© z 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? Type of offense Where When s-'i-nze !� /o X1,'1 %�!S-W4) we.,��i/�r�y -:7-/+-�"/°y-z0%L Na 47141, &S-h-j;h Edey l_,fAelk -A %Z -ref• -%L/ 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? 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) 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certfy that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number l S issued on W', M expiring on Ol b =11/y . 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 o City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant I'/,11q>AA , AA Date y 3 vaz d R 0 2015 STATE OF IOWA ) COUNTY OF JOHNSON ) S cribed pnd sworn to before me by f �( on this day of l T -r — I 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 Chauffeur's license /– 4 1__ /V" - Sign 7 e V Sign7e o�f Poli l6 C n f 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. d.�f�GIC sfi K �C�iii1J Signat re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update rf- � -/S Date clerk7AXIORNB4DGF PPL92014amended.00c 0312015 Mar,30� 2015 11,31AM D l v of Criminal Investigation Io.3690 P. 6/6 In r. Le• LV I) L.IJIm IIY biCrK — V ly VI IUWd l,I L Ufriminal HWOry I" \ 1 I ul t I ,,V'folYAj� �•`41Ye��,_1 Tot Iowa IDivlsloa of Criminal Investigation Support Opora ([0119 13 u t•eatt, V Floor 215 F. 7"' Street De moiues' lowes 50319 (915)925-6066 (515) 725-6080 tram an Iowa 9as�t�r �- ,eeord Clieok on: Mast tvame (man I#prllpo DCIAcoouniNumber: (FappGcablc) From; City of Iowa City City Clark's; Off lee 410 F. Washhlgion Street Iowa City, IA 52,240 Phone; 319-356-5041 Fax; 319-356-5497 �++`it_r7Mr RImale OFemale G I'Ly 'i_ cl r. lower Uty, io'i Middle Name (moo, -Es Vq iqv6L sects Waives' InfOPInailOn:.Wlthout a signed waiver &mn the suhfeet of the request, a complefe criminnl history record may not be roloosable, per Code of Iowa, Chapter 692,2. For complete criminal history record information, as allowed by )aw, always obtain a waiversifsnaturo from thesebiect of the a eauest. WaiveP Agknfse: i hereby glvo pumlesion for the ebove tequrming of2reial to conduct on loam cilminal hlslofyrawid chcck With nco Division ofCrtmmat rnvutittallen(DQ, Any Criminal historydata MIUMngmethat isMwAi ned6ytheDCImeybereleasedasallowedbylaW- WalverSlgnalure; 7riimin-M History Record Check Resulf (DCI Iueonly) As of 30/ i`7 a search of the provided omne and data of birth revealed: No Iowa Csitninal Mstory Record found with DCT Iowa Criminal Hisfox'y Record attached, DCI # DCI initials__, Receivedme�hlar:��jy�%2015 2:53PM No -3636 C40WADOT SMARTER ! SIMPLER 1 CUSTOMER DRIVEN W�'tiN,1CiVVa�itil .£ t�V Office of Driver Services PO Box 9204 I Des Moines, IA 50306-92C4 Phone: 51.5-244-9124 1809-532-11211 fat_ 51 S-239-1-Sa7 www..iowadot.gou Certified Abstract of Driving Record Inquiry Date: 3/19/2015 DL/ID #: 137AC0905 (IA) Customer 7F: 5249393 Name: Sagastume Palma, Class: C ID Status: None Marlon Estuardo Address: 306 AIDAN DR Audit #: 6568272 DL Status: VAL Issue Date: 12/27/2012 CDL Status: None City/State: WEST LIBERTY, IA Expiration 01/04/2018 CDL Cert None 527761653 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 306 AIDAN DR Restrictions: NONE Restriction None Date of Birth: 1/4/1971 Supplement: Mailing City/State: WEST LIBERTY, IA Sex: M t.. 527761653 0 2015 History Information C' Convictions :OVria. C�tV.lo Citation Date Conviction Dake AAD Expl.na€Bon County dO1s 03/07/2012 04/10/2012 -_... .. .._.....o ;592 Speed (10 mph &under in 35 55 mph zone) ... 'Muscatine IA 10/07/2014 :12/01/2014 F02 No Child Restraint Muscatine IA... Name: Sagastume Palma, Marlon Estuardo DL/ID: 137AC0905 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 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: �.i••"•••:v/%'4 3/19/2015 IOWA yf,•+ D.O.T'e% ill .......• $EQS / r Office of Driver Services ,y dRIYEF_�= Iowa Department of Transportation Name: Sagastume Palma, Marlon Estuardo DL/ID: 137AC0905 Julie Voparil From: Julie Voparil Sent: Tuesday, June 30, 2015 9:47 AM To: 'marlonsagas@outlook.es' Subject: Taxi Driver I.D. As of June 1, 2015 Red Line Cab was no longer operating as a taxi business. Your taxi driver identification card for this business is no longer in effect. If you choose to drive for a currently licensed taxi business you will need to have a new identification card specific to that business name, and have a new photo taken. Julie Voparil Deputy City Clerk City of Iowa City 410 E. Washington Street Iowa City, IA 52240 (319)356-5040 CITY OF IfJWA CITY UNESCO CITY OF LITERATURE