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HomeMy WebLinkAbout15-162I I � I ONE CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. (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 3. Contact Information (REQUIRED) 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? e Where When Ar ?c 0, —6�v 1 �),s zuC�j ala What happened to the charge? (Circle one) Convicte 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 What happened to the c e? 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? 40 Type of offense Where When 9, Have you eve,�ppplied to be an Iowa City taxi driver using a different name? If yes, please provide the DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C You must apply for an individual Department of Criminal Investigation Report (form avai (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) i WWw rr�pq ue iZ5 D cn ssa 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereb� ce(r�tify that I have is ued to me by the Iowa Department of Transportation a v lid Chauffeur's license number /1 %X X issued on 2I� expiring on �. 1 understand that if I falsely que tions 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, hapt{eer�2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant r ! rt" t Date 13/ I� STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and to before by e? 1 l r v R, - t4 h) r r4 rz on this ),S day of 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 L)2- SignatLffe of P lice Chief 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. Signa ure of City Clerk or designee ate azrkfr I❑RNB GD PPr92o14.m.,I tl.DOC 0312015 Office Use Only a Approved application s- d c-� DCI report W State certified driving record Website update ,p .. cn azrkfr I❑RNB GD PPr92o14.m.,I tl.DOC 0312015 Iowa Department of Transportation (.Jt ce oil €.]rt &'.'?ffv1re5. i loll l tl10 b32-1121 F w+�BOY 'JQ+1, L)f�S iulijlflrm;, IA '.dl3fi9,2.I:1.1: `•14 4d�-Q i'34 Certified Abstract of Driving Record Inquiry Date: 8/11/2015 DL/ID #: 509XX2752(IA) Customer #: 4903269 Name: Holida, Matthew Class: D ID Status: EXP IA Ryan Conviction Address: 1417 W BENTON ST Audit #: 9202272 DL Status: VAL Issue Date: 06/26/2015 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 10/31/2020 CDL Cert Status: None 522464902 Sign/Signal Endorsements: 3 CDL Med Status: None Mailing Address: 1417 W BENTON ST Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 10/31/1986 Mailing IOWA CITY, IA Sex: M City/State: 522464902 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 05/05/2008 09/25/2008 A33 Drug/Drug Related Johnson IA IA IA Conviction 07/15/2008 09/25/2008 A20 Operating While Johnson IA Intoxicated 06/13/2014 12/08/2014 M14 Fail to Obey Traffic Johnson IA Sign/Signal Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation JUR 07/15/2008 A98 OWI Test Failure IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 07 26/2008 01/21/2009 A98 OWI Test Failure IA IA Name: Holida, Matthew Ryan DL/ID: 509XX2752 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do 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: IOWA as D. '0. T Name: Holida, Matthew Ryan DL/ID: 509XX2752 8/11/2015 Office of Driver Services Iowa Department of Transporation 08/.1-2/2015 12:58PM FAX 3193397302 nsiAug,12, 20152 1:57PM Cab Div of Criminal Investigation .err iq,1nSTATE . . WA Record Request Form tinr.�Y.: Tor Iowa Dlvhlon or Criminal Investigation Support oporetlon3 Bureau, r" Floor 21S E. 7" Street Des Molnes. Iowa 50319 (SIS) M-066 (515)'725.6080 Fax am requesting en Iowa Crlmtn l,213MMe (mandatory) N[�h )ate of Birth mandatey.� 160001/0003 fFA%)11933C2 " 2894 P. 3/6uu4003 DCC Account Number: ^9967_F (If applicable) From: _Yellow Cab of Iowa City P.O. Box a428 Iowa Cltyt IA. S2244 (319) 335-9777 Phone: Fax: (319) 399.7302 Mdf f 4W fonder (misauorr) IN mile ❑Feruale 1RIA4 7-355( ��4 r waiver [s{/orntarlon: Wlthout a aligned waiver from the subject of the regvalt, a complete grlmtne{ history record qts not be releasable, per Code of Iowa, Chapter 692,2. For y F complete crlmEnef h}/toYy.reeor� Informaslon, ea allowed by low, blWays obtain a WAIYEralenaGlre hnrw the n,A1.....na-.......__• Wafuel' R61a`irse:. herabyplva ponaollon for As abed, rm JAVUligarlon(DCO. Any mIm)not hlnery data apnoomina mo that waltrer SlBnafure: Motel to oanduer an Iowa criminal binary rdaerd shack with tho Division of6dminal aiedd/by IjieRVl nlwy be released as allowed by law. (PW ate ons» A9 of / a search of the provided name and data of birth revealed: © No lows Criminal History Record found with DCl t+' Iowa CriminalFtistory Raoord attached, DCI # %?.� r �;.. DCT initialsh� c 5 -n c:> DC1-77 (0825/10)i-- r S n, C/1 Received Time Aug, 11. 2015 9:26AM No. 5126 -. 08/12/2015 12:59P3f FAX 3193397302 Aug•12, 2015 1,58PM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONvICTI DCI 00796341 ONS ONLY PAGE 1 OF 2 DATE PRINTZD- DCI:00786342 2015/09/12 NAME: HOLIDA,MATTHEW RYAN DOB SEX RAC MGT WOT EYE HAIR SKN POB 19861031 M W 600 300 GRN BLN FAR NC ADDITIONAL IDENTIFIERS PHOTO AVAILABLk: y CGS RECORD • •+ 01 ARRUSTSD 20060924 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA713-6A SVAGLARY 31D DEGRSNS TRO: 101985701 COURT DISP08ITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- D1 IA STATUTE; IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 FECR077331 CHARGE CLASS; NON CONVICTION TRK#: 101985701 SENTENCE DEFERRED JUDGEMENT FINE $750 PROBATION 2Y DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED 2009D50S AGENCY: IA052D200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRKOt 1A0043M01 COURT DISPOSITION AGENCY, IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED OV98TANC8 COURT CASE ID: 06521 SRCR093297 CHARGE CLASS, MISDEMEANOR CONVECTION TRK#, 1AG043MDI LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 2D 03 ARRESTED 70090715 AGENCY: IA0520100 CORALVILL9 PD CHARGE NO- 01 IA STATUTE TA321J.2(A) OPER VER WH INT (OWI) / 18T OPP TRK#t 1A004N301 COURT DISPOSITION DIBP EFF DAT 20061208 20061208 20061208 20071217 DIBP EFF DAT 20080915 Z 0002/0003 No. 2894 P. 4/6 08li2/2015 12:59PM FAX 3193397302 Au g. 12. 2015 1 : 5 8 P M Div 0f Criminal Investigafi0n AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- O1 IA STATUTE; IA321J.2(A) OPER VKH WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCRO$4026 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#t IA004N301 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 2D FINE $1230 12 HR ONI COURSE OR OWI WEEKEND PRO 04 ARRESTED 20140614 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 02 IA STATUTE IA124.414 POSSESSION OF DRUG PARAP31SENALIA TRK#: 1AOOJ9102 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: XA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 SMSM098252 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; IAOOJ9102 SENTENCE PINE $100 DCI 00786342 PAGE 2 OF 2 DISP EFF DAT 20080925 20080925 20080925 DISP EFF DAT 20141024 AN ARREST WITHOUT DIBPOSITXON IS NOT, AN I=:rCATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVXSION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE ACI. 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 INVESTXGATION r Z0003/0003 N0, 2894 P. 5/6