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Home My WebLink About16-006n ' &1% awn M+a.v._ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 t9) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. //s'—t a (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 Middle Last 2. Address (REQUIRED) 7 1 00 4� [ L!IUri 3. Contact Information (REQUIRED) Email: _ ( I1 ?P cy c 2r L6`66 Phone: _7 ,-7 1 :ZG15L, (All dten communication ent via email) T 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? Type of offense Where What happened to the charge? (Circle one) Convicted Dismissed Deferred When Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Convicted Dismissed Where When Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? WEI. Type of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? When If yes, please provide the mare DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIT~ 1' EVJAFW You must apply for an individual Department of Criminal Investigation Report (form availableupon request) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) Li 0212015 APPLICATION FOR TAXICAB VEI4ICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number -- -5�1„� 1/� � issued on r—t t- ]j2(,expiring on 7-�- 7Qi6i . I understand that if I falsely answer any questions -In this application, that this application"mr"a`y 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_ ��- — - Date�� STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by i C I�C. j co on this _ day of irec �lC ti'4 20l LQ 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). FI ur's license I I or designee Dat 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. :2 Lr�ies k , � Slgndture of City Clerk or designbe Oate r-� sa Office Use Only a 491 Approved application = DCI report State certified driving record uti Website update - CierVITAXIDRNDADGE PL92014wme &d.DCC 0312015 1UV Vi4 0 0 T a wwwJowadotgov SMARTEIR I SIMPLER I CUSTOMEE MIEN Office of Driver Services P£7 Box T2041 Iles Moines, A 50306-9204 Phone: 515-244-9124 18D&532-1121 I Fax: 515-239-1837 www imadot.gov 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 custodyof said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so ceriory. 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: Name: Montalvo, Eric DL/ID: 430WWO332 Y"y IOWA s y 1/4/2016 Certified Abstract of Driving Record }: 0. Tr Inquiry Date: 1/4/2016 D./ID#: 430WWO332(IA) CDL Permit Class: None Customer #: 1943121 Class: D CDL Permit Issue Data: None Name: Montalvo, Eric Audit #: 9679405 CDL Permit Expiration None Date: Address: ZIOe-S SCOTT BLVD APT 83 Issue Date: 01/04/2016 COL Permit Endorsements: None Expiration Date: 04/11/2019 COL Permit Restrictions: None City/State: IOWA CITY, lA 522403017 Endorsements: 3 ID Status: None Mailing Address: 2100 5 SCOTT BLVD APT 83 Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Mailing IOWA CITY, IA 522403017 Supplement CDL Permit status: ELG City/state: Date of Birth: 4/11/1978 ._ C61. Cott Status: None S.; M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Montalvo, Eric DL/ID: 430WWO332 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 custodyof said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so ceriory. 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: Name: Montalvo, Eric DL/ID: 430WWO332 Y"y IOWA s y 1/4/2016 }: 0. Tr t ea Office of Driver Services ®Sit Iowa Department of Transportation fu C=` ti e ` �tf Jan'11. 2016 11;22AM 9iv of Criminal Investigation N' D' h I I 8 l;'4 F"�.,.._. Cler- ._._------- 01/0a/2010 11:&' -361 x,....-/002 4STATE OF IOWA)" Criminal History I' To: lows Divislom of Criminal Investigation Support Operations Buvcau, P' Floor 215 M 9'h Street Deg Moines, Iowa 503)9 (515)725-6066 (515)725.6080 Fax I ant ieemestinc an Iowa Criminal hfistrnv Record Check om DCl Accouot Nontber: Lf cc;i - F (I(applicable) From: City of Iowa CCChy Clfy Cleric's OfFiee 410 E. Washington Street Iowa City, IA 52240 Fhoue: 319-356-5041 Fax: 319-356-5497 Last Name (mandato) First Name (,nandalory-) Middle Name (roaun,mendea) As of a search of the provided name and date of bitlh revealed M0A+6,Ivra L Date of Birth (mandolory) Gender (mandatory) Social 6ecuri , Nlumher (r=con,mendcd) 11 % N(ale ❑remale - f (^ �� WaiveP Information: Without a signed waiver from Ilse subject of the request, a complete criminal history record nsay not be releasable, per Code of lows, Chapter 692.2, For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of tlsa re nest. Waiver Releose: 1 hereby give p un iision ,Cor the abate « gocsling of :ial la concha ata Iona criminal historyrecord chtek with rhe Division of Criminal hmstigaslon(DCO. Any aiminal history, data conecmingme Mal is mainsamed by the DCl lay be re leased as allowed by law. )Waiver Signalure Iowa Criminal History Record Check Results As of a search of the provided name and date of bitlh revealed No Iowa Criminal History Record found with DCI' ❑ Iowa Criminal History Record attached, DCl A ru DCl mitrals r. t DCI -77 (08/25110) Received Time Jan. 8. 2016 10:39AM No -5017