Loading...
HomeMy WebLinkAbout16-003CITY OF IOWA CITY 410 Last Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX IDENTIFICATION NO./ — (-)L% (Office Use Only) APPLICATION FOR TAXICAB I 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 1. Name (REQUIRED) /Qp 2. Address (REQUIRED) 2L Last 3. Contact Information (REQUIRED) Email: Farm 1c �Jmedtac� / S_ 66 n�C Cell Phone. (All written c hmunication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) ,�/ Q¢ ,2A b. Taxicab Business Name (REQUIRED) __ yF W `e a 5. Prior experience in transportation of passengers: Is 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where /� When G)eMV1 A/e f Misr_�,,:f T�iv.�.,,, % . �rY , w _1 . s What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? &0 Type of offense Where When 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 Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please tideThe riame(s),__ DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTlFIEf DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIIEF:REVkR;N 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 `M VV 62V issued on !.Z•Q?• y'i expiring on a-oyye . 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant STATE OF IOWA ) COUNTYOFJOHNSON ) and sworn to before me by on this ) 1 day of the State of Iowa k**k************###*********kk*k*k*****************************kkkk***********R***************k*Fkkk**********#*********k*********************** 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 orwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Co/de,). Expiration date of Chauffeur's license T Sig ur of Police 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. Sign ture of City Clerk or designee Pate r.� Office Use Only {+ a f Approved application DCI report State certified driving record " Website update cies✓ AXIDRmBADGEAPPL920iaaniended.DOC 0312015 L/� Iowa Department of Transportation Osf+ce Ot Driver Servttes 7p41 FTee) WG 53211,21 ` 111111 FSO t30Y 9204, Des M(Ann, IA 5030 9204 ,15-244 (,1I,>4 �`li I'AX 515233183/ Inquiry Date: Name: Address: City/ State: Mailing Address: Mailing City! State: Convictions Certified Abstract of Driving Record 117!2016 DL/ I D #: Connolly, Robert Class: Raymond JR None 21 Second St Apt 2 Audit #: VAL Issue Date: Hills, IA 52235 Expiration Date 12/04/2018 Endorsements: PO BOX 7 Restrictions: 429VV6230 (IA) Customer #: 2681075 D ID Status: None 86621.33 DL Status: VAL 12/03/2014 CDL Status: None 12/04/2018 CDL Cert Status: None 3 CDL Med Status: None Corrective Lenses Restriction None Operating While Supplement: IA Date of Birth: 12/4/1959 HILLS, IA sex: M 522350007 History I nformation Citation Date Conviction Date ACD Explanation Count JUR 09/11/2008 02/05/2009 A20 Operating While Johnson IA JUR Intoxicated 09/09/2009 06/28/2011 A20 Operating While Johnson IA A98 OWI Test Failure IA Intoxicated Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. rccident Date —Case Number JUR 5/16/2015 859386 IA Operating While Intoxicated Test Refusal/ Test .Failure Violations Occurance ACD Explanation JUR`W' 09111/2008 A98 OWI Test Failure IA �.— •"" 09/0912009 A98 OWI Test Failure IA . to ;v Sanctions ;Yr Type Effective End ACD Explanation Occurrence JUR JUR Revoked 09/22/2008 03/20/2009 A98 OWI Test Failure IA IA Nam e: Connolly, Robert Raymond JR DLI l D: 429VV6230 Fail to Refile IA q ®�tOWA S 2 R2 Suspended 112105/2009 Failure IA 12/03/2011 863 Revoked 112/0912009 IA 12/03/2010 A98 ISuspended 108/04/2011 01/30!2012 ent of IA p27 Suspended 10/03/2013 11113!2013 053 Suspended 110/2412013 10/28/2013 D53 Nam e: Connolly, Robert Raymond JR DLI l D: 429VV6230 Fail to Refile IA q ®�tOWA S 2 R2 D. 0. T. ' ; IIA Failure IA IA of IA IA ent ofIAA o ent of IA ilA 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 date: this document, at Ankeny. Iowa JUIC[f gid, 117/2016 q ®�tOWA ,` D. 0. T. ' ; 41, Office of Driver Services l owa Department of Transporation Nam e: Connolly, Robert Raymond JR DLI I D: 429VV5230 ol'ian 7. A 164-2.32FM Cee6iv of Criminal Investigation No, 4581 P. 1/4 • - •'- �' •� (FAR)31833821.v raw2/D02 ,(Cnrirgr ` OF Criminal HistoryRecord Check is Request Form acY.,�o'+l Tot Iowa Dlvl5lon of Criminal Invesllgatlan Support Operations Bureau, 1" Vloor 215 It, 7" Street Des Moine;, Iowa 50319 (515) 725.6066 (515)'725-6080 Fax DCI Account Number: _9967—F (irepplleeble) Aroml Xaliow Cab ofTowa City _ P.O. Box 428 Iowa Clty, Li, 52244 (319) 338.9777 Phone; Pax, (319) 339.7302 Morale QFemaie I IYF.3/ rralvertnjorrnarton! Without a signed waiver from the subject ortho regpast, It complgtc grlminal hlstory reoord may not be releasable, per Coda or Iowa, Chnpter 692.2. ForSqMXjUj criminnl historPr000ro Informatlon, as allowed by low, always obtoln a lvnlver sinnatura rrnm the eahle.,. -r,,--------- Waiver Re%asel I here byglvo perminlon far the ebM taqu4lIng olllc4l to condool an IM odmIna) hbtotyreoord check with Iho blvlslon of Crlminel Inrcedgmtoa (DCO, My erlminel hIr(gry do la ivnoamingme that 13M a fni, I ned by the DCf may he (4oesod ee allowed by law, Waiver sl"qnaturer I., ,� Z"? NIA Zowa CrIminal History Record Cheek Restnita MCI! W„nly) As of i S (� , a search of the provided name and date of birth revealed: ' moi- ts.` © No Iowa Criminal H{atory Record found with ACT Iowa Crlmina! History Record attaohad, DCT # %-7_6 5 a% DCI initlals �= DCI -7? (08/25210) r v G7 Received Time Jan. 4. 2016 12:57PM No.4113 Jan. 5. 2016 2:32PM Civ of Criminal Investigation ADDITIONAL IDENTIFIERS SC HEAD TAT CHEST TAT UL ARM TAT UR ARM 01 ARRESTED 20060518 PHOTO AVAILABLE; Y CCH RECORD "'w'* AGENCY: IA0520000 IOWA CRIMINAL HISTORY DCI 00776527 IA STATUTE IA708-6 FELONY CONVICTION PAGE 1 OF 3 COURT DISPOSITION DATE PRINTED - AGENCY; IA052015J JOHNSON CO DIST COURT 2016/01/05 DCU00776527 INTIMIDATION WITH A DANGEROUS WEAPON COURT CASE In: 06521 NAME: CONNOLLY,ROBERT RAYMOND CHARGE CLASS; FELONY CONVICTION CONNOLLY,ROBERT RAYMOND JR SENTENCE DOB SEX RAC HOT WOT EYE HAIR SKN POB 19591204 M W 509 172 BLU BRO SUPERVISED PROBATION TO DCS NJ ADDITIONAL IDENTIFIERS SC HEAD TAT CHEST TAT UL ARM TAT UR ARM 01 ARRESTED 20060518 PHOTO AVAILABLE; Y CCH RECORD "'w'* AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA708-6 INTIMIDATION W/DANGEROUS WEAPON TRK#; 101868501 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO. 01 IA STATUTE: IA708.6-2 INTIMIDATION WITH A DANGEROUS WEAPON COURT CASE In: 06521 FECR076027 CHARGE CLASS; FELONY CONVICTION TRM 10IB66501 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $750 CIVIL PENALTY 20070914 PROBATION 2Y 20070914' SUPERVISED PROBATION TO DCS FINE $750 20090213 SUSPENDED PRISON 5Y 20090213 PRISON 5Y 20090213 PROBATION UPON 3Y - 20090213 REVOCATION OF DEFERRED JUDGMENT REVOKED 20090213 IMPOSED 5Y 20110628 02 ARRESTED 20080911 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF TRK#: IA0053NOI COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO. 01 IA STATUTE: IA321J.2(A) OPER VSH WH INT (OWI) / IST OFF COURT CASE ID: 05521 OWCRO84680 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA0053N01 No. 4587 P. 2/4 a' Y3� .s-1 Jren. 5, 2016 2 : 3 2 P M Div of Criminal Invesflgalion DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION RESTITUTION SENTENCE DEGREE - 1970 SUSPENDED JAIL 173D JAIL 180D FINE $1250 PROBATION 2Y IMPOSED 173D REVOKED 03 ARRESTED 20090909 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IP716.3 CRIMINAL MISCHIRP IST DEGREE - 1970 TRK#: IA0070M0I CHARGE NO- 02 IA STATUTE IA708.4(2) WILLFUL INJURY - CAUSING BODILY INJURY TRK#; 1A007OM02 CHARGE NO- 04 IA STATUTE 17321J,2(B) OPgR VEH WH INT (OWI) / 2ND OFF TRK#; 1A0070M04 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST,COURT COUNT NO- 01 IA STATUTE: IA716.9 CRIMINAL MISCHIEF 2ND DEGREE - 1978 COURT CASE ID: 06521 FECR088338 CHARGE CLASS: FELONY CONVICTION TRK#; 1A0070M0I RESTITUTION SENTENCE FINE $750 SUSPENDED FINE $750 PRISON 5y COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA70B .2(1) ASSAULT INTRNT TO INFLICT SERIOUS INJURY -1978 COURT CASE ID; 06521 FECR0BB330 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 1A0070M02 RESTITUTION SENTENCE FINE $625 SUSPENDED FINE $625 PRISON 2Y COURT DISPOSITION DCl 00776527 PAGE 2 OF 3 DISP EFF DAT 20090205 2009020$ 20090205 20090205 20091201 20091201 DISP EFF DAT 20110626 20110628 20110628 DISP EFF DAT 20110628 20110628 20110620 No. 4587 P. 3/4 S) an, 5. 2016 2:32PM Div of Criminal IivestIgatlon No.4587 P. 4/4 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 04 IA STATUTE: IA321J.2(3) OPER VEH WH INT (OWI) / 2ND OFF COURT CASE ID; 06521 PECRO86336 CHARGE CLASS; MISDEMEANOR CONVICTION] TRK#; 1A007OMO4 LICENSE REVOKED RESTITUTION SENTENCE JAIL 6M FINE $1875 04 RECEIVED 20110620 AGENCY: IAOE2015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA690.4 CUSTODY IOWA DEPT OF CORRECTIONS I TRK#: CBODC4G01 INMATE #: 6793503 CUSTODY AGENCY: IA0770150 ADULT PAROLE SVC A 20120425 PAROLED CUSTODY AGENCY IA0770150 ADULT PAROLEISVC B 20130407 DISCHARGED D DCI 00776$27 PAGE 3 OF 3 DISP EFF DAT 20110620 20110628 AN ARREST WITHOUT DISPOSITION IS NOT AN IN ICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CAIMINAi INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN NLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITXV IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT QONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION