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Home My WebLink About15-247CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1 82 6 (3 19) 356-5040 (319)356-5497 FAX 1 2. 3. IDENTIFICATION NO. l �j —aQ7 (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 Name (REQUIRED) 'Ll :ol Ch, Address (REQUIRED) ,S 6� i Contact Information (REQUIRED) Email: 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: - N/z __. ci .1c �'•� %"Z� `�11��'s�'w /c.tiCell I communication sent vias email) 61 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense I Where 2 -,- - N �4, sI Spt-ea( 61 - —r When y�z� �Lv+ - -( , `//ZG 13 Mww�!'� i� :3 er What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense J• Where When .� / rd 9 Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please ,v d en Uli DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATEVD.k*TIFFED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C1= & REMEW ts- — You must apply for an individual Department of Criminal Investigation Report (form available upo r request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 022015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a yalicf Chauffeur's license number S f7 [7 % issued on �� .' •', ;'expiring on �5 . I understand that if falsely answer any questions In this application, that this app1icat& may be denied. I of reelhat 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 applic ioF, and I f her agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions Tifle 5, Cha ter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date d / / f STATE OF IOWA ) COUNTYOFJOHNSON ) q Subscribed and savor to before me by 1w �CrCe C Cvc, on this 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 I�C)51:`7 lk(.-Z) Signature of Police Ohief or designee too�S r� 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. Signat City Clerk or designees Office Use Only Det w 4 Approved application;CD a DCI report State certified driving record c 5 r Website update i cn n -a �o Clerk/FAXIDRII ADGE FL92014.yn.,d d.DGG h 0312015 Iowa pa of Transportation _taClifte ol u w Swam 51-5-244-9124 PAX- 515�m 1837 Inquiry Date: Name: Address: City/State: Certified Abstract of Driving Record 10/6/2015 DL/ID #: 188AD8779 (IA) Customer #: 4450616 Aragon, Ambar A class: C ID Status: EXP 306 E A ST LOT 94 Audit #0 7097065 DL Status: VAL Issue Date: 07/03/2013 CDL Status: None WEST LIBERTY, IA Expiration Date: 07/18/2016 527769323 Endorsements: NONE Mailing Address: PO BOX 62 Restrictions: NONE Date of Birth: 7/18/1991 Mailing WEST LIBERTY, IA Sex: E City/State: 527760062 History Information Convictions CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Ex lanation Coun JUR 04/26/2013 05/29/2013 F02 No Child Restraint Muscatine IA 04/26/2013 05/29/2013 F02 No Child Restraint Muscatine IA 06/09/2015 06/27/2015 S92 S eed Bremer IA Name: Aragon, Ambar A DL/ID: ISSAD8779 Pursuant to Iowa Cade §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. r.> In witness whereof, I have caused my signature and the seal of the Department to be set upon this c&mentF-Vt Ankeny, Iowa this date: r'a CD �low 10/6/2015 a,,.,.� ,• I-70 Y : ! Office of Driver Services Iowa Department of Transporation State of Iowa Division of Criminal Investigation 215 E. 7' Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check /1 Wallr-In Your name: r fig, Address: 36 Z.- yq S Ca 4 Ci /Stat /Zi : 4_),c.,V [,`b.c Phone #:(3/' Svl - 7 &0 Remiestinu an Iowa Criminal histnry re .nrrl rhpok nn - Pill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Vombre (mandatory) Middle Name 5egrmdo Nombre (recommended) A,a So t7 DCI USE Date of Birth recha Aacimie no (mandator)) Gender Genese (mandatory) Social Security Number (recommended) ti ❑ Male Female 3 q r� — — q s3 Waiver Signature 'irma ' re request is on yourse please sign If the request is on somenne else, write id!A ) e�— Results Y c Qt 4 dans DCI USE ONTy ca ti 0 As of td a name and date of birth check revealed: : ` ® ,� r . c-' r -s _ PM No record found ` CO X CD ❑ Record attached DCI # D yl DCI initials r w �r Receipt Number of requests —I-- x $15.00 per last name = Total amount $ Method of payment: cash money order check # Cardholder's name Ani hor A(n o npq DCI initials W ----------------------------------------------------------------------------------------- Credit Card # Exp. Date DCI -83 (09/09/ 10; Revised 10/ 1 / 10; form reviewed 08/11/14) q NMterCard or Visa Y c Qt 4 dans es l ca 0 .,_.