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Home My WebLink About15-178sr CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52 240-1 826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. IS- l ! ( (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 Middle 64/k- 2. Address (REQUIRED) 60.2 Fh.)c 7/ad 70.ui C;fiY, r'cWr. 5,2Y6 3. Contact Information (REQUIRED) Email: r, -.A -2;1(.66Q Cell Phone: _-30-DSS-oy(,C (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) e) ) /6 ij-26. b. Taxicab Business Name (REQUIRED) JC1(c"c✓ C.tJ 6C Yi 5. Prior experience in transportation of passengers: S h s 2 � ern iLC//o GJ C& 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _V-e� Type of offense Where When d Sez �r��itaG14 4¢cl1 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offensne Where When Sv��rY Sy�in �n G'oa�f�� pl/ What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil Other Has your driver's license or chauffeur's license been suspended or revoked in the last five ye'ir§3 17 , Type of offense Where n Q -� _71 rn s 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pnyide they al 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 certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ybo 5h'D7 issued on ;2-12-.70CSexpiring on 3-0-22Y20 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 he a taxicab driver is granted, to comply at all times with all of the provisiong�of Title 5, Chapter 2, of the pity Code. (Needs to be signed in front of a Notary Public) Signature of Applicant & 5�6� Date 8"•2� STATE OF IOWA ) COUNTY OF JOHNSON ) bscribed an fl swq to'�fore me by � O(: t� C �`Q I on this r day of ,eLufl K. _ LE ajs Notary Public in and for the State ofI wa � 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), date or license S/ r/Z D �n 0 ^ ' 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. Signature of City Clerk or designee �/a G ate N �� e• 4 Office Use Only UI C C= ii -^C rV r^•r- Approved application ::-.,I -o ITI DCI report w State certified driving record :R- R Website Website update o W cienaraeiozivenoce PL92014amended.00c 0312015 osalAug 6. 2D17,;2:3.8PMCab `Div of Criminal Investigation , No 4817 P• 1/b -' (FAX)3193382i,,,,' ,...../002 STATE OF # Criminal History Record Check rehjyr.,RoquestForm DCI Awount Number; _9967-F llhppneehle) To: Iowa Division ofCrlrAlhal Inveattgntlan SupportQporationtbUreou,I"Floor From: Yellow Cab ofIown Clty 215 E. 7" Strout P.O, Box 428 Des Moines, Iowa 50319 (515) 725-6066 InWa Clty, TA., 52244 (515) 725.6080 Fax • Phone: (319) 3389777 • Fax: (319)339-7302 rrafver lnJarmafion, Without a signed waiver from the anbl'eot of the request, o complgte grlminal history mord rpay not be releasoble, per Code of Iowa, Chapter 692.2. For comniote erlminal history record Informgtlon, aA allowed by Taw, always obtain a waiver signature from the guhlant er rhn .. ,,.e. Walydr l[e/daSe: I hcfeby give pefmluian for the ebeve roquening omelet m conduel sn Iewe aNminel hlslory teoord check with the Dlvlston of Criminal lnvouloitlon (DCII, Any oriminel hfito fydata wnumingme t 11Ir malnmined by the DCI m►y be ro)essed pr allowk by )ew. A n n Waive? Signature; JRCyUlLS � (DCtusO only) As of�`Cj a scaroh of the provided name and date of birth revealed: 13 No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCI # aM UI DCI initials� Q MI- ,rr <II DCI -77 (08/25110) Received Time Aug, 5. 2015 7,39AM No. 4625 Aug. 0, 7015 2 : 3 8 P M Div of Criminal Investigation Na, 4817 F. 2/6 IOWA CRIMINAL HISTORY FELONY CONVICTION DCT 00316955 PAGE 1 OF 5 DATE PRINTED- DCI:00316955 2015/08/06 NAME: HLAIR,ROD BLAIR,RODNEY DEAN DOB SER RAC HOT WGT EYE 19660305 M W HAIR SRN POB 601 276 14A2 HRO MED TA ADDITIONAL IDENTIFIERS SC R WRIST SC UL ARM CCH RECORD *** 01 ARRESTED 19840401 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA715-1-6 PLS USE FIN INSTR 2ND TRK#: L25803001 COURT DISPOSITION AGENCY: IA0520150' JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA715-1-6 FLS USE FIN INSTR 2ND CHARGE CLASS: STATUS UNKNOWN TRK#, L25803001 SENTENCE JAIL DISP EFF DAT 11D 19840412 ' T CHARGE NO- OS IA STATUTE IA714-2-2 THEFT 2ND TRK#: L25803101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: OPERATE MOTOR VEHICLE W/OUT OWNER CONSENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#+ L25803101 SENTENCE PLEAD GUILTY DISP EFF DAT JAIL 72D 19840822 19840822 03 ARRESTED 19859625 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- Ol IA STATUTE IA714-2-5 THEFT STH DEG TRK#: L25803201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-2-5 THEFT 5TH DEG CHARGE CLASS- MISDEMEANOR CONVICTION Aug, 6. 2015 2:38PM Div of Crlmina; Investigation DCI 00316955 PAGE 2 OF 5 No, 4617 P. 3/6 TRK#; L25603201 IOWA CITY PD CHARGE NO- 01 SENTENCE THEFT 2ND DEG TRK#: L25803501 DISP EFF ART PLEAD GUILTY AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-1-3 19850708 PINE $100 19850708 04 ARRESTED 19850725 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA713-5 BURG 2ND DEG TRK#: 425803301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: THEFT 4TH CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L25BO3301 RESTITUTION SENTENCE DISP EPP DAT PROBATION lY 19851002 SUSPENDED 90D 19851002 05 ARRESTED 19B60320 'aAEliiQ- 'S4^ PNi-�7�S.�F1 THEFT 2ND DEG TRK#: L25803401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-2-2 THEFT 2ND CHARGE CLASS: FELONY CONVICTION TRW L25003401 SENTENCE DISP EFF DAT PROBATION 5Y 19870129 CREDIT 22D 06 ARREBTED 19860610 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-1-3 THEFT 2ND DEG TRK#: L25803501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-1-3 THEFT 2ND DEG CHARGE CLASS, FELONY CONVICTION TRK#r L25803SOI Aug. 6. 2015 2.38PM Div of Criminal Investigation No. 4817 P. 4/6 RESTITUTION SENTENCE PROBATION 07 ARRSSTSD 19070107 AGENCY: IA0520000 CHARGE NO- 01 WILLFUL INJURY TRK#: L25801601 COURT DISPOSITION AGENCY: IA052015J COUNT NO- O1 TERRORISN SY JOHNSON CO SO IA STATUTE IA708-4 JOHNSON CO DIST COURT IA STATUTE; CHARGE CLASS: FELONY CONVICTION TRH#t L25803601 RESTITUTION SENTENCE CONCURRENT W/CYCLE DOA 06/10/86 PROBATION SY 00 RECEIVED 19070129 AGENCY: 1ADS2015M OAKDALE IMCC TRK#: L25803701 INMATE #: 803150 CHARGE NO- 02 IA STATUTE IA714-2-4 THEFT ATH TRK#: L25BO3702 COURT DISPOSITION ACI 00316955 PAGE 3 OF 5 DISP EFF DAT 19870129 DISP EFF DAT 19870226 19870226 AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-2-2 THEFT 2ND CHARGE CLASS: FELONY CONVICTION TRK#: L25803701 SENTENCE DISP EFF DAT PROBATION 5Y 19870129 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714-2-4 THEFT 4TH CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L25803702 SENTENCE DISP EFF DAT CONSECUTIVE SENTENCE WITH CT 01 19870129 JAIL 90D 19870129 COURT DISPOSITION AGENCY: Aug. b. 2015 2,38PM Div of Criminal Investigation No. 4817 P. 5/6 DCI 00316955 PAGE 4 OF 5 IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: TERRORISM CHARGE CLASS: FELONY CONVICTION TRK#! L25003703 SENTENCE DISP EFF DAT JAIL 5Y 19870226 CONCURRENT WITH CT 01 6 02 19870226 CUSTODY AGENCY: XA053015C ANAMOSA MENS REFTY A 19570226 RELEASED BY COURT ORDER CUSTODY AGENCY: IADS3015C ANAMOSA MENS REFTY B 19870226 RECEIVED RETD ON COURT ORDER CUSTODY AGENCY: IA077015G ADULT PAROLE SVC C 19880302 PAROLED CUSTODY AGENCY- IA052015M OAK04LE IMCC D 19881208 PAROLE REVOKED CUSTODY AGENCY: IA077015G ADULT PAROLE SVC R.ffilI4ARR-0.- CUSTODY AGENCY: IA0770150 ADULT PAROLE SVC F 19890831 DISCHARGED FROM CRIMINAL JUSTICE SYSTEM 09 ARRESTED 19081116 AGENCY: IA0520000 CHARGE NO- 01 PAROLE VIOLATION TRK#: L25803801 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 JOHNSON CO SO IA STATUTE IA906-1 JOHNSON CO DIST COURT IA STATUTE- IA906-1 PAROLE VIOLATION CHARGE CLASS: FELONY CONVICTION TRK#: L25803901 SENTENCE TO SERVE BAL 06/10/86 10 ARRESTED 19901102 AGENCY: IA0520200 CHARGE NO- 01 THEFT LST TRK#: L25003901 COURT DISPOSITION IOWA CITY PD IA STATUTE IA714-1-6 DISP EFF DAT 19900703 Aug. 6. 2015 2:3BPM Div of Criminal Investigation No. 4811 P, 6;6 AGENCY: IA052015J COUNT NO- 01 JOHNSON CO DIST COURT IA STATUTE: IA714-2-1 THEFT IST CHARGE CLASS: FELONY CONVICTION TRK#: L25803901 SENTENCE JAIL l0y 2D CREDIT 11 RECEIVED 19910913 AGENCY< IA052015M CHARGE NO- 01 THEFT IST TRK#: L25804001 COURT DISPOSITION AGENCY: IA052015J COUNT 140- Oi OAKDALE IMCC IA STATUTE IA714-2-1 INMATE #: 803150 JOHNSON CO DIST COURT IA STATUTE_ IA714-2-1 DCI 00316955 PAGE 5 OF 5 DISP EFF DAT 19910912 THEFT IST CHARGE CLASS: FELONY CONVICTION TRK#: L25804001 SENTENCE ➢ISP EFF DAT JAIL l0Y 19910913 9 PAROLED CUSTODY AGENCY: IAD77015G ADULT PAROLE SVC B 19960714 DISCHARGED FROM CRIMINAL JUSTICE SYSTEM 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 83 RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCT. 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. r ` DIVISION OF CRIMINAL INVESTIGATION Irw+ra department of Transportation Moe rR Umwer 8emces (Tal Free) SW --32.11121 -9124 i �F'{3 f3ox 321,Y1, DmMoms, IA 5m305 X2514 fAX. 515 239 0 1337 Certified Abstract of Driving Record Inquiry Date: 8/20/2015 DL/ID #: 960AA9807 (IA) Customer #: Name: Blair, Rodney Dean Class: B ID Status: Address: 602 FOX TRL Audit #: 8838470 DL Status: Wearing corrective lenses Medical Certificate Issued Date Issue Date: 02/12/2015 CDL Status: City/State: IOWA CINIA Expiration Date: 03/05/2020 CDL Cert Status: 522409209, Endorsements: L CDL Med Status: Mailing Address: 602 FOX TRL Restrictions: NONE Restriction Supplement: Date of Birth: 3/5/1966 Mailing IOWA CITY, IA Sex: M City/State: 522409209 CDL Medical Examiner's Certificate 2228817 None VAL VAL Non -Excepted Interstate Certified None Certificate Specifics Exiolanations Medical Examiner First Name Krista Medical Examiner Last Name Ford Medical Examiner License Number A116069 Medical Examiner National Registry Number 3880330225 Medical Examiner Jurisdiction IA Medical Examiner Phone 319 337-9066 Medical Certificate Restriction 1 Wearing corrective lenses Medical Certificate Issued Date 01/16/2015 Medical Certificate Expiration Date 01!1612017 Date Added to CDLIS Driving Record 01/16/2015 History Information Convictions Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]UR 108120/2007 389515 IA 109/07/2007 392736 IA Name: Blair, Rodney Dean DL/ID: 960AA9807 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: 'r �y„r7ytF 8/20/2015 10WA D. 0... yr Office of Driver Services Iowa Department of Transporation Name: Blair, Rodney Dean DL/ID: 960AA9807