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Home My WebLink About15-177j 1 i aI 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 3S6-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 15--1-1-1 (Office Use Only) APPLICATION FOR TAXICAB / 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 irst 2. Address (REQUIRED) G le 3. Contact Information (REQUIRED) Email: VY\t'y1 (&ZtA ' Jik-C L! rM1 I � LOYNII Phone: 31 1 -6V-050Z (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) �lr 5. Prior experience in transportation of passengers: D /r5/A0vkD J CU 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? / NoIN01 Type of offense Where What happened to the charge? (Circle one) Convicted Dismissed Deferred When Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Q. 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 STATETIFII DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CH�REVVfW You must apply for an individual Department of Criminal Investigation Report (form availatde onmeque,,, �; t (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) -zeV M s j 02/2015 a r, APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certi/ t have issued to me by the Iowa Depa �m�e�t�� jo�f Transportation a slid Chauffeur's license number `� 16 fi n1 issued on Of Ito on a 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 provisiqns pftitll 5,,Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican Date a dJ 46/5 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by _ c,,r.� , ky—XS n'L� on this � s day of .�l WENDY S. MAYER __j NofaWPub Tic in and the Stafe of Iowa My Commission Expires 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 Chauff ur's license d 2 0 ) I Z Z I Si ature of Alice Chief or d gnee 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. ---k - C)(IaAltl Sign ure of City Clerk or desi ee Office Use Only Approved application DCI report ate State certified driving record Website update Z -; L r . -v ClerkrrAXIDRIVBADGEAPPL92014amended.DOC 03/2015 M y. MANI WADOT Office of Driver Services PO Box 92,041 Des Moines. IA 50306-9204 Phone: 515-244-+9'1241 Sdii}-532-1121 I Pass_ 516-233-1837 wwwJawadotgory Certified Abstract of Driving Record Inquiry Date: 8/19/2015 DL/ID #: 476AF1324 (IA) Customer #: 5344889 Name: Mendoza Zambrano, ]are Class: D ID Status: None Marilu Address: 2409 ASTER AVE Audit #: 9307206 DL Status: VAL Issue Date: 08/04/2015 CDL Status: None City/State: IOWA CITY, IA 522406732 Expiration Date: 10/15/2020 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2409 ASTER AVE Restrictions: NONE Restriction None Date of Birth: 10/15/1992 Supplement: Mailing City/State: IOWA CITY, IA 522406732 Sex: F History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]UR 03/15/2008 432371 IA Name: Mendoza Zambrano, Jare Marilu DL/ID: 476AF1324 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: �0@••.."""•:�%+4 8/19/2015 IOWA• �+ �s Office of Driver Services Iowa Department of Transportation N Name: Mendoza Zambrano, ]are Marilu DL/ID: 476AF1324 Gn Frriug• [U. LU 17 /,jjrlv01v of Ur i m i n a I Invest gat i on No. 3649 P. 7/7 • ..2/002 r 1OWA MvislOn of ('`.r ndiial lrlvesligation !Vupport Ope.rallons liurean, 5" l~Innr 215 E, 7"' St1-( 1)4S Moines, 10WO 90319 (515) 725.6066 (515) 7255-6000 FS)c 1 ale re uestiran )uwacrin iial Lm NaiTle (ufanddory) / 4/n c4c,ZK DOID of Birth (mandatorvl /0- /S - I7IZ 14ist-(3111 ReCor d Check R('qneEt Forel: Record Check on: F1rst*e (man j a I� Gender !7(;! Account IN'LIMbor - r. FOO (ifailphCahlc) •� (rulil: C of low— 410 E, Woshinglon Street �)Covla C:i[Y, rA 52x40 Phone: 319-356-5041 >:az; 319-346.5a3.5x37 """ _...-----�— •.-�_. OM21e �'Felnale 111111 � ddle Name 190 4 Social -S-tcuriti' Number 07q - gt.z.<,VC, IWiraver rnforhtfrliol►: 'Without a signed waiver from the subject of the request, a completa criminal history record may not be r in rd bk, per Code of IOWA, Chapter 692.2, )For con ,lett criminal history record information, as allowed by low alw2y obtain b walvci'si nature from the sub ecl of there nest_ IWafvee Release: l hereby give pcnnisSion fol the abov h1VA51ig4U011 (DCI). Any criminal 1►islory data cOneernia rlfe 1•I/waver Sag n to lva cl- regoesiing official lu conduci an Iowa crimihal hisloryrecord eh¢ek ti llh Division o ie Division CrinuBal s aimauted by the DCI may be F01O td W allowed by law. As of _ '� a search of the pmovided 118w, and dale of birth reveale No Iowa Ca;Inillal I listor), Record found Willi OCI loua C:rii>>iuAl IJislor ) )tectfn'1 altaavhed,l)C'1 as__-•- c 1)('I-77 (08/25/10) Received Time Aug, 19, 2015 12:40PM No -5860