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Home My WebLink About16-042r IDENTIFICATION NO. I G 0 Lf --2 _ l 1 (Office Use Only) MItccmzrz MIIM®jq, CITY OF IOvvA CITY APPLICATION FOR TAXICAB i MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington Street Iowa City, Iowa 52 240-1 82 6 Failure to complete the "required" information will result in denial of the aoAfication (3 19) 356-5040 (319) 356-5497 FAX a� 1. Name (REQUIRED) I 2. Address (REQUIRED) 73� �� W Ct �� 1 {4 �o�`f 0 3. Contact Information (REQUIRED) Email: �S�IQn 1Q Ct f5�/S I -S II Phone: LS lc; q-Ot%ao (All written c uo(rhrel nicationserIVvia email) 4a. Chauffeur's License expiration date (REQUIRED) 10/o l( e b. Taxicab Business Name (REQUIRED) 5. Prior experienncce in tran ortation of passengers: � t -n "i e +-0 4' S 1� r S Skctr Qack n �2U t2 �] SlSII�-tars CLh�i 61h.-1"- SS %1C/� W tom, ll �� S' } iJLCIV 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? C Type of offense Where W en Q Cts ,rI �• 76,31 �3ba`•t s i)F r1 ul LA- n f D 03 0 002 h tt aened to h char irc a on S h� �Z O p�C3v s 11 /c7�hr j Convicted Dismissed a Suspended Ple ui Other 7. Have you been arrested / charged with any traffic offenses in the last five years? _ ( X&� VVI at 1 idNNenea to me crarge! (uircte one) Convicted Dismissed Deferred SuspendePI ad Guilty Other [ _ 8. Has your driver's license or chauffeur's license been suspended or revoked in thefive ast five ears? 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) IfJL }o DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02.!2015 � IBJ 44 --i74ULA -24- --FCS APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereb certify that I a e 'ssued to me by the Iowa Depart ent of Transportation Ill Chauffeur's license number % 1 issued on expiring on �. 1 understand that if I falf�answer any questions in this application, that this app ication ay be denied. agree tha 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 applicatio and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions f Tit1 5, hapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant 4Date STATE OF IOWA ) COUNTY OF JOHNSON } Subscribed and sworn to before me by 'A 4, g&j isi . C) Ems— on this day of kA Irt t. %1 L o 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 10 10 2 (2b 1 Signature of Police hief or designee C�,�oII(p Date AFTERAPPROVAL 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 o f City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update �a etet Clero-✓rnxlDZlveaoGe PPL92014amended.000 0312015 !UVVADOT wNv icawadatgav SAxAFTEE 1 51MRLIP I£llsTO'+'��_PFIR {dE�.�,,,..,,:,�..,w....._.,�,�.<., Office of tlrivar Services PO Box 9204: Des Moines. IA 50306-9204 Phone -515.244-97241800-532-11211 Fax 515239-1837 www.iawacki Certified Abstract of Driving Record Inquiry Date: 3/1/2016 DL/ID #: Customer #: 1045217 Class: Name: Graper, Ashley Nicole Audit #: Address: 2018 WATERFRONT DR TRLR 44 Issue Date: 10/03/2014 CDL Permit Expiration Date: City/State: IOWA CITY, IA 522404424 Endorsements: Mailing Address: 2018 WATERFRONT DR TRLR 44 Restrictions: NONE ID Status: Restriction Mailing IOWA CITY, IA 522404424 Supplement: City/State: CDL Status: VAL Date of Birth: 10/2/1982 ELG Sex: F CDL Medical Examiner's Certificate 781ZZ78B5 (]A) CDL Permit Class: None A CDL Permit Issue Date: None B503828 CDL Permit Expiration None Nathan Date: lTeansporta[lon 10/03/2014 CDL Permit None Thomas Endorsements: 10/02/2018 CDL Permit Restrictions: None NONE ID Status: None NONE OL Status: VAL None CDL Status: VAL Medical Examiner National Registry CDL Permit Status: ELG CDL Cert Status: Non -Excepted interstate CDL Med Status: Certified Certificate Specifics s0~#aW '•"•"'•,, -N Explanations Medical Examiner First Name e--. tlrlr,,SI Nathan lTeansporta[lon Medical Examiner Middle Name IbvraeDepartme lof Thomas Medical Examiner Last Name Broghammer Medical Examiner License Number 007140 Medical Examiner National Registry Number 4928157227 Medical Examiner Jurisdiction IA Medical Examiner Phone (319) 378-1515 Medical Examiner Type Chiropractor Medical Certificate Issued Date 11/04/2014 Medical Certificate Expiration Date 11/04/2016 Date Added to CDLIS Driving Record 11/O7/2014 History Information Convictions Citation Date Conviction Date ACD Explanation County IUR 12/05/2011 03/09/2012 S92 Speed MO 10/23/2014 02/13/2015 S92 Speed (10 mph & under In 35-55 mph zone) Johnson IA 03/19/2015 05/06/2015 S92 Speed Wright IA Name: Grapeq Ashley Nicole Dll 781ZZ7885 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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: Name: Groper, Ashley Nicole DL/ID: 7SIZZ7885 s0~#aW '•"•"'•,, -N 3/1/2016 a.: D. 0. T � e--. tlrlr,,SI Drivereaf lTeansporta[lon IbvraeDepartme lof Name: Groper, Ashley Nicole DL/ID: 7SIZZ7885 o2Feb. 19. 2016;,12; 00PM4 CabDIY of Criminal Investigation (rAx)319338_No.7991 STATE OF IOWA ,I- +tmm� H •Criminal HistoryRecord Check • a uest Vorm Toe Iowa Division at criminal Investigation Support Operations Bureau, ill Floor 213 B. 7'" Street Dos tdolnes, Iowa ,50319 (515)723.6066 (519) 729.6680 Bax I em reaueatina an ►nu., CrW..1 Ml.t.n, n ...n -d P. 1/42/003 DCI Account Number: 9967-F (If Appueable) From: Yellow Cab of Iowa city P.O. pox 428 Iowa City, IA. 5224 a Phone; (319) 338-9777 I+ax: (319) 339-7302 LOU Name InuindmorA First Name intandatwyy, (reeommanded Date of Birth mandato Gender menduo 'Social•Securit/y�Number tecommendad) V ! 2 ! � ❑Male ,�Femate �� VG.`- � �Cj IfWalverl'ifarmaflont Without a signed waiver Cram the subject or the request, a Complete grlminol history reoard may not be releasable, per Cade of lowo, Chapler 692.2. For complete criminal history -record Information) as allowed bylaw, always obtain a waiver Signature from the sub eat of the request. Waiver Releasel1 hereby give permission to,the above7 aealn amclalioconductSoIowaorlminalblstoryrecordcheckwiththeDiWdonof17dminal lnvpllgeuoh{oCq. Any criminal hlnotydais eendaml met is tallied by may be reieasadaallowedbylaw. Waiver Signatures ,wv w �• aaaaaa ala a,a,aa aVa a.%Ga. as VW%AG,]ILIA lO (OCs use only) As of a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI -U Iowa Criminal History Iteeoxd attached, DCi # IpSU � � 3 _.., y V); DCI lnitials� DCI -77 (08/25/10) Received Time Feb, 17, 2016 12:11PM No, 7596 Feb,19. 2016 12:00PM Div of Criminal Invesh gah on IOWA CRIMINAL HISTORY DCI 00650813 )MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- DCI:00650813 2016/02/19 NAME: GRAPBR,ASHLEY NICOLE DOB SEX RAC HGT WGT EYE HAIR SKN POE 19021002 F W 505 170 GRN SRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLEs Y TAT BACK TAT L FOOT TAT L SHLD TAT R ANKL TAT UL ARM No, 7991 P. 2/4 CCH RECORD *** 01 ARRESTED 20010e!2 AGENCY: IA0920100 WASHINGTON PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESSION/MARIJUANA TRW 055399601 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-5 POSSESSION MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 055399601 SENTENCE DISP EFF DAT D$FERRED JUDGEMENT 20011009 COURT COSTS 20011009 PROBATION 1Y 20011009 JAIL 7D 20020117 FINE $250 20020117 COURT COSTS 20020117 RESTITUTION SERVICE 20020117 REVOKED 20020117 02 ARRESTED 20020305 AGENCY: TA0920100 WASHINGTON PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOXICATION TRK#: 055423901 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: YA123.46 CONSUMPTION / INTOXICATION COURT CASE ID: 08921 SMSM036477 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#+ 055423901 SENTENCE DISP EFF DAT JAIL 5D 20020320 CREDIT W/TIME SERVED 20020320 No, 7991 P. 2/4 Feb.19. 2016 12:00PM Div of Criminal Investigation DCS 00550813 PAGE 2 OF 2 03 ARRESTED 20080620 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 TA STATUTE IA726.6(7) RNDANGERMENT/NO INJURY TRXV: lAO04FTOI COURT DTOP091TION AGENCYi IA052015J JOHNSON CO DIST COURT COUNT NO- 01 XA STATUTE: IA726.6(7) CHILD ENDANGERMENT/NO INJURY COURT CASE ID: 06521 AOCROB3748 CHARGE CLASS: NON CONVICTION TRK# % IA004FT01 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20081024 PROBATION lY 20OB1024 DISCHARGED FROM 20090819 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUXLT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI, IN THE ARSFNCR OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNXSFi81]. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR TNQUXRY. DIVISION OF CRIMINAL INVESTIGATION Wo Y No. 7991 P. 3/4