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Home My WebLink About15-067r , �A111�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. /5-t:) 1 9-7 (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) Failure to complete the "required" information will result in denial of the application First Middle 2. Address (REQUIRED)�1 {lEtf�ri (p�Ci i 3. Contact Information (REQUIRED) Email: -Ulu _ (G. I �lD M 1�ty'<It 1 -fG'MCell Phone::(Cl -cis 3 (All written communicatio ent via email) 4a. Chauffeur's License expiration date (REQUIRED) fh1 i D 1 r 1 I ao 1 b. Taxicab Business Name (REQUIRED) 1 rtl n, 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?_ Type of offense Where When TaerroQ rwv, mlyl&\ ftPr Y -A-, CLWm,,jA14- M t I i What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where Other At i' e SSyco� 1'a- I t -7 What happened to the charge? (Circle one) C (4-0--t- o n Convicted Dismissed Deferred Suspended Plead Guilty Other Pci,4 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? (1 CS 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 cer i that 1 have issued to me by the Iowa Department of Transportation a vali Chauffeur's license number (� SG1 V S 1 3 issued on gra 1$expiring on 0 I understand that if I falsely answer any questions in this application, that this application may be denied. I agree th t 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, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant ?e�-Q-�A, A A1,A Date Q (Q I I'S STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1 �-air,;,,te c N on this ; LD -L day of MtA a I)A, aeaz 9-- S. MAYER I Notary Public in aQQ for the State 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). ojmc Signatur of"Polir/ ef or designee ao Ir 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. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. Sig e of City Clerk or designee Date Office Use Only n� Approved application DCI report ` State certified driving record Website update ClerWAXIDRIVBADC, EAPPL92014mended.DOC 0212015 Page 1 of 2 CZ10"WADOT TV?{VJ1.+iJ0Vlr`ai' Gt90V Office of Driv€ir sorvlces PO Beit 9204 1 Des Motnes PA 5U306-9294 Phone: 515-244-9124 1.600-532.-1121 [. Fat 515-239-1637 YiYtW.iCVVi a{l�s'..gil Certified Abstract of Driving Record Inquiry Date: 3/6/2015 DL/ID #: 615AH5743 (IA) Customer #: 5997533 Name: Robinson, Tierra Class: D ID Status: None Caprice Address: 2401 HIGHWAY 6 E APT Audit #: 8898358 DL Status: VAL 4212 Issue Date: 03/06/2015 CDL Status: None City/State: IOWA CITY, IA Expiration 06/21/2017 CDL Cert None 522405792 Date: Status: Endorsements: 3 CDL Med None Status -- Mailing Address: 2401 HIGHWAY 6 E APT Restrictions: NONE Restriction None 4212 Date of Birth: 5/21/1992 Supplement: Mailing City/State: IOWA CIN, IA Sex: F 522406792 =1 History Information Convictions Cltatiun tate ronviction Dxate „Cu Explanation ANO Count;' ':]ohnson IUR IA 12/17/2012 02/04/2013 B64 Insurance Card 08p1E®,i Iowa Department of Transportation Name: Robinson, Tierra Caprice DL/ID: 615AH5743 Pursuant to Iowa Code §321.10, 1,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: Name: Robinson, Tierra Caprice DL/ID: 615AH5743 3/6/2015 3/6/2015 Q"i,,o iowa0. •.••.• Office of Driver Services 08p1E®,i Iowa Department of Transportation Name: Robinson, Tierra Caprice DL/ID: 615AH5743 3/6/2015 Mar. 13. 2015 1:34Pt Div of Criminal 1 n v e s t 1 ; a t i 0 n on o r Sz Y111B U4:41MI Cdr of Iowa City 319339-5393 page 2 f Oo°iulla aM History Re04gd Check Request IFOYm To: Iowa Division or Criminal Investigation $r.pport Cperalions Hul•eara, V door 215 E. 711' street Des Moines,Iorra 50319 (515)725-6066 (515)725-6080 Fox I am requestiar, an Iowa C runmal rvsiu� {.�=u �u w- Yhl6t N2me Qnaadota First Mame (mandaln Date of Birth (msndatan) Gender maodalory) OU -Om - Iq q a- OMale WRBVCY 1"formigJ1011: without a signed waiver from thesubjeet of the request, a complete criminal history record lrnay not be releasable, per Code of Iowa, Chapter 692.2. For coma late crlminal history record information, as alloyed by law, always No. 2399 P, 1 DCI Account Number: 1� (ifapplice6le) From: City of Iowa City City Clerk's ®PtIIra 410 E Washina46rs street lo"a City, JA 52740 Phone; 319-356 5041 Fax: 319-356-5497 c e q - g - ' a�as 1p �I+emrale 3a _ walJep Ra1214.58;Ihetrby givoyetmis6ion fbr Nea6weroglwsiing oRicial to conduct an Iowajta iA l alloWcrecord checkvvida ahobivisfon ofCrvnlnai Invcsggat(6a NCb• My eriminal history da:a concerning =that malntalned by the DCT may 6e mlaexd ey eliow<d bylaw. Waiver S19)IMUre; Iowa C-rj tI jng A1skory Record Cheek Results (DCT nse Daly) As of 3�/3 �� , n search of the provided name and date of birth revealed: No Iowa CriTninel History Record found with DCX Iowa Criminal Histoxy Remd attached, DCI # 99510 -rr lP DCT iniflals DCI -77 (08/25/10) r:_. M,, 19 HIS INIPM Na.2855 Ma r. 13. 2015 1:35 PM Div of Criminal Investigation No. 2399 P. 2 IOWA CRIMINAL HISTORY DCI 00995102 COURT DISPOSITION PENDING PAGE 1 OF 1 STATUS UNKNOWN DATE PRINT$0- 2015/03/13 DCI!00995102 NAME- ROBINSON, TIERRA CAPRICE DOB SEX RAC HGT NGT EYE HAIR SKN POB 19920621 F B 504 27.2 BRO ELK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y _ „- CCH RECORD * * * - Ol ARRESTED 20131210 AGENCY: IA0520100 CORALVILLE PD-- '_ CHARGE NO- 01 -TA STATUTE IA715A.5 TAMPERING WITH RECORDS - 1907 TRK# : 1AOO I5H01 ... COURT DISPOSITION - AGENCY: IA05201SJ JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA715A,5 TAMPERING WITH RECORDS - 1967 COURT CASE ID: 06521 AOCRID3833 TRK#: 1ADOISH01 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $625 CIVIL PENALTY 20140407 PROBATION lY 20140407 UNSUPERVISED PROBATION, INFORMAL PROBATION REVIEW I1/1/14 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 HE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCI. 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