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Home My WebLink About14-118� r i tIIIa ;l CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 3S6-5497 FAX 1. Name 2. Mailing Address Authorization Number I U-- I) R (Office Use Only) 05D LIVE clqz APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) 3. Telephone: Home LI I - S a If 0 t cc �) Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense 11 — r\ P ,. Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?_A-)O_ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? A Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) deNta dmbad9 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `7 7."S ZZ� �� 1 1 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 Wil 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 (Needs to be signed in front of a Notary Public) Signature of Applicant / Date J� / YOU ARE NOT VALID TO DRIVE A T N 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 L.J ; l I C . C,r tip� �1_ On this ) Vr� day of jliL go l'-1 \1 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). Sign attr a of POIi e ie 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. mature of City C erk or designee s-l-�2\l�A Dae ' Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/s" (width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update cierdta d-vcadga pDzoia dog 03/2014 Apr.17• 2014 11:39AV h np..lLV IY IL•VJI IV, oom a� M0 itrnru,-y�` r�e51 SFi I• Div of Criminal Investigation �I Ly bItIK blty UI IVrva bILY STATE OF IOWA (CrimiinzA 06fory Reeoyd Check kequest Form, To! Iowa Division of Criminal Investigation Support t]peraticns lTureau,l'` T+'loor 219 E. 9th Street DOS Moines, Iowa 50319 (515) 785-6066 (515)725-6080 Fax Tam ramrnetlna an Tnwa r.elminnl TTi.cfory lZncnl'd Cisecfc on: No 5,606 P. 1/11 N U•9VII P. (/( DCIAccountTTurnber: 4m�-- [ tifappffoablc) From; City of Iowa City City Clerk's Office 410'R. Washington Street Towa elty. IA 52140 Phone: 319-356-5041 Far; 319-356-5497 Last Name mandelo ,Tdrst Name craot aty) Middle lNAlne teco,moiondcd) OP—r 6,A W1 L -L G1ZU� Pate of Birth mandelo) Gender (nisi oq•) Social SII Number rccommsoded Z/- a'y - I q 7 6 1VTal0 ❑Fefuale y ro— l5- Waiverlrrformailolr: 'Without a signed waiver from theanbjoot of the request, a eompleto erlminal hi3tory record may not be releasable, per Code of Iowa, Chapter 691.2, Bnr noml2its ovimfnalhlstory reeord Information, as aflowed bylaw, always obtain a waiver si nafure frmn the sub act of there nest Waiver Release: Ihcrcby give permission fornco above reQuesting official to condvet an Iowa crfmhmi hlslory record check with the Division of Criminal lnvestigaliontDCQ, Any criminal hisfoty data concemhigma thatismainleinc hylhe DClmeyhcrcicescd PeolInwedhylaiv c Waiver s6rature: . Iowa Criminal History Record C ek Results As of a search of the provided name and date of birth revealed: U, No Iowa Criminal History Record found with D CI' Iowa Criminal history Record attached, DCT # Mon N D CI fnitialsIb— eceived Time_Apr, 15.--2014-12:02MNo, 7593 APO T 2014 11:39AM DIV Of Criminal Investigation No.5606 P. 2/11 IOWA CRIMINAL HISTORY NON CONVICTION DCI:00669087 NAME: CRUZ,WILFREDO ORTEGA ORTHOA,WILFREDO CRUS ORTEGA,WILLIR DOB SEX RAC NOT WGT EYE 19780429 14 W 509 177 BRO ADDITIONAL 7PENTIFIERS SC L HND CCH RECORD *** DCI 00669067 PAGE 1 OF 1 DATE PRINTED - 2014/04/17 HAIR SKN POB ELK 01 ARRESTED 20030105 AGENCY; IAD700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA321J-2-2A owl TRK#: M00087001 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE IA3210r.2(A) OPER VEH WH INT (Owl) / IST OFF COURT CASE ID: 07701 OWCRO25872 CHARGE CLASS: NON CONVICTION TRK#: M00087001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20030422 PROBATION 18M 20030422 COMMUNITY SERVICE 40H 20030422 DISCHARGED FROM 20041027 DEFERRED.JUDGEMENT AN ARREST WITHOUT D18POSXTION IS NOT AN 'INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, HUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DC1. 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 Iowa Department of Transportation Office of Driver Services (toll Free) BUG/ 532.1121 PO Box 9264, Des Moines, to W366-9264 515 244.9124 FAX; 515 239 1837 Mailing Address: 2619 INDIGO CT Mailing City/State: Convictions IOWA CITY, IA 522406810 Endorsements: 3 Restrictions: NONE Date of Birth: 4/29/1978 Sex: M History Information CDL Med Status: None Restriction None Supplement: Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 4/28/2014 DL/ID ik; 775ZZ9301 (IA) Customer ff: 3632398 Name: Ortega, Will Cruz Class: D ID Status: None Address: 2619 INDIGO CT Audit V: 5918783 DL Status: VAL Issue Date: 05/04/2013 CDL Status; None City/State: IOWA CITY, IA Expiration Date: 04/29/2018 CDL Cert Status: None 522406810 Mailing Address: 2619 INDIGO CT Mailing City/State: Convictions IOWA CITY, IA 522406810 Endorsements: 3 Restrictions: NONE Date of Birth: 4/29/1978 Sex: M History Information CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Ex la nation Count lUR 01/05/2003 04/22/2003 A20 Deferred Judgment OWI Muscatine IA 08/13/2013 09/17/2013 1 Miscellaneous Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Exiplanation JUR 01/05/2003 A90 OWI Test Failure IIA Sanctions Type Effective End ACD Explanation Occurrence JUR ]UR Revoked 102/12/2003 08/11/2003 A90 I OWI Test Failure IA IA Name: Ortega, Will Cruz DL/ID: 775ZZ9301 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,