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Home My WebLink About16-059rlllPit �� * MWlcctm` �'tlJiF� al CITY OF IOWA CITY 410 Es 5t Wasbl ngton 5l Feet Iowa Cil Y. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name(RFOUIRLD) - 2 Address (REQUIREDi, IDENTIFICATION Ni _ J L_�7- ✓ V l:j-q Office Use Only) APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m, to 3 p.m., Monday — Friday) Failure to ronlDlete the "required" information will result in denial of the application 3. Contact Information (REQIJIRF_Dj 4a. Chacffeurs License expiration date (RE3UIRED) b. Taxicab Business Name (KEQUIRED) 5, Prior excerience in transportation of passengers: U r;ell Phone 6. Have you ever been arrested I charted with any misdemeanors ardlor felonies in this State or elsewhere? T eofoffense Where When !-0 �s<r�lc VVI -@t happened to the charge? (Circle one) �ConviuteDismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic nffenses in the last five years? Type of offense T1 > I ja t LIL>b i Where When What happened to the c . e? Circle one) Convicte ., Dismissed Deferred Suspended Plead Guilty Otner 8, Has your driver's I cense or chant eur's license been suspended or revoked in tho last five years' i 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 names) �i i :E�! DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE ,; C'LRFI�$ DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CH6F-i2EVIEW You must apply for an individual Department of Criminal Investigation Report (form availab"FefaponmcIi (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY),-',_"`" tv Y cn �'' 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have is ued to me by the Iowa Department of Transportation a v lid Chauffeur's license number issued on 19rzl��expiring on __j 01 1 understand that if I falsely �n,we aMyquc 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 tha 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, It authorization to be a taxicab driver is granted, to comply at all tines with all of the provisions of -I itle 5, hapter 2, of the City Code (Needs to be signed in front of a Notary Public) Signature of Applicant. r ! nj�I Data T �1 TxxxwxYxk.kxxxxxtf a}{.kk*}#AAAa*f 41A}*******xxx+k={{A}A**#xx**k{#kx==#=n=x{!kx#kxakk*#{*k-Fart##xxi#+xk***A**+YtFAYWyYi***+k+a+.k[}:.i***xxvFxxk#=x*k# STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by i o- -e t 1 _ t4 r11 i r cz on this % 7j day of Subscribed _ 1 _ of Iowa 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 CChhauuffeur's license lU 2- 11 -1> t Signal, a 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. �'f�Ci,zai' 7� '�Cd.}�./ Signa ere of City Clerk or designee _�7 /l� ate Office Use Only v Approved application a �; DCI report - - State certified driving record »; w Website update �r * St Ct! ti Crxwr !]Rnar Uc FL920aEme oa: 03/2015 Iowa Department at Transportation ' iYihr'e or i. mef urr wx—s ; loll i ir'e) is 1G 53' 1 tJ'1 (.7110 .{?fit, UL-, hl31i7r;. 4A.103)692. 4 111 4q A4's' 1633/ Convictions Citation Date Certified Abstract of Driving Record ACO Inquiry Date: 8/11/2015 DL/ID #: 509XX2752(IA) Customer #: 4903269 Name: Holida, Matthew Class: D ID Status: EXP Conviction Ryan 07/15/2008 09/25/2008 A20 Address: 1417 W BENTON ST Audit #: 9202272 DL Status: VAL Intoxicated Issue Date: 06/26/2015 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 10/31/2020 CDL Cert Status: None Si n/Si nal 522464902 i 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 ACO Explanation Count JUR 05/05/2006 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 Fall to Obey Traffic Johnson IA _ Si n/Si nal i Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation JUR 07/15/2008 A98 I OWI Test Failure LA Sanctions Type Effective End ACD Explanation Occurrence 7UR ]UR Revoked 07/Z6/2008 01/21/2009 A98 Oth`I 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 Transportatlon, do an official record currently In the custody or said Office, and that I have been authorized by the Director of the Iowa Depdrlment 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 + ' _'.r,,�y$,�'�(A�rj{� 8/11/2015 IOWA r D. Q.T.: Office of Driver Services Iowa Department of Transporation Name: Holida, Matthew Ryan DLftD: SD9XX2752 08/1-9/2015 12:58PM FAX 3193397302 os�Avg,12 20152 1:57PM Cob 6iv o t_Criminal Investigation 00001/0003 ra•Nx>sts39e2�Vvk 2894 P,� 3/6,003 STALTE OF IOWACriminal HistoryRecord ;rte%"'•; Request e Tot town Division or Crlmloal Investigation SupportOporatJonaBurau Id Floor 3151:. 7'" Street e Acs Molnes, Iowa 50319 (513) 725.6D66 (535)'775.6080 Fax Tf-0I h ate of Birth ,ne anoey O/31 J�jU DCC Aoaougt Number: 19967-F (rreyyudebld) From: Yellow Cab of Iowa City P.O. Box q28 Iowa City, IA, 5224a (3I9) 338.9777 , Phone: Fax: (319) 399430 11A h W !order saau �� iffi112ala ❑Famale R'JAn w4z91'er'[gfarmaN0n: Without a signed Waiverfrem the subjectoEthe retlaort, a Complain prlrnrnar htstory regard rgay net by ralansable per Cada of Iowa, Chopter 692,2, Fer Complete crlminat hlatery,recol� Informaslon, ea siiowdd !fy law o Wd p Obtain a Walver DI nature from the t06 ger of ihd Ye 4pst ') y WaIVtYRBiBUSe;1 heeveyiJve permhekn foreho ebeva rdquesling el:ialel:e oendude M tour ddminel hindyreeore edeek wllh mo Glvlslon drdrmraer rnve:ftaddn (OCp, Any eAminer hinny dw dgedemrna mo Ihn b malnlelnedlby l ej?¢I ne.y be releaysd u euowed by law. wabeer Signature: agar ata ony) A9 of / a search of the provided name and data of birth xevealod: ❑ No lows CriMiftal History Record found with DCI tows: CritninJl! History R600rd attached, DCI # 78'6 3��, r. ` , •;,� DCJinitials_ n`• 'vG•a o: DC1-77 (0825/10)� to Received Time Aug. 11. 2015 9:26AM No, 5126 _ 08;1.2/2015 12:59P31 FAX 3103397302 Au8.11. 2015 1:58PM Div of Criminal Investigation IOWA CRIMINAL HISTORV M28D$MEANOR CO2ZVX0TIOZfJ ONLY DCI:00706342 NAME; DOLIDA,MAI`TESW RYAN DOB SEX RAC HGT WOT EYE MIR 19061031 M W 600 300 CRN BLN ADDITIONAL IORNTIFIERS P140TO AVAILABLE: Y CCN RECORD *** 01 A9RXST6n 2006D924 ACEMCY; XA0520200 IOWA CITY PD CHARCR NO- 01 IA STATUTE IA713-6A HUAOLALUY 3RD DECR80; TRK@: 101985701 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- D1 IA STATUTE; IA713.6A(1) BURGLARY 3RD DEORBE COURT CASE ID: 06521 FECRP77331 CHARGE CLASS; NON CONVICTION TRX#t IDISGS701 SENTENCE DEFERRED JUDGEMENT FINE $750 PROBATION 2Y DISCHARGED SROM DEFERRED JUDGEMENT 02 ARRESTED 20000505 AGENCY: IA0520200 IOWA CITY PD CHAROE NO- 01 IA STATUS& 1A1241401 (5) POSSESSION OF A CONTROLLsp 9DE8TANC8 TR 4 , 1A0043M01 COURT DSSPOBTTION AM=i IA052015J JOHNSON CO DIST COURT COUNT No- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED 8089TANCk COURT CASE ID: 06521 SRCROB3297 CHARGE CLASS, MISDEMEANOR CONVICTIC47 TRK#i IA0043HOI LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 20 03 ARRESTS:) 70090715 AGENCY: IACS20100 COP.ALVILLE PD CHARGE NO- 01 IA STAT179 TA321J.2(A) OPER VEH WH INT (DNI) / 1ST Or? TRM 1A004N301 COURT DISPOSITION DCI 00786342 FACE 1 OF 2 DATE PRINTM- 2015/08/12 SM PCB FAR NC AISP EFF DAT 20061208 20061206 20061208 20071217 OIBP EFF OAT 20080925 90002/0003 No. 2894 P. 4/6 08/!2/2015 12:59PM FAX 3193397302 Au g, 12. 2015 1: 58 PM Civ 0f Criminal Investigaii0n AGENCYA IA052015J JOHNSON CO DIST COURT COUNT NO— O1 IA STATUTEe IA321J.2 W OPER VEX WH IN•P (OWI) / IST OFF COURT CASE ID: 06521 OWCR084026 CHARGE CLASS: MISDEMEANOR CONVICTION TRKN, IAOOAN301 DRUNK ORIVINO SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 20 FINE $1750 I2 HR OWI COURSE OR OWI WZRK= PRG 04 ARRESTED 20140614 AGENCY: IA0520400 IOWA CITY VNIV SEC Pb CNAROB NO- 02 XA STATUTE IA124,414 FOSSIDSSiON OF DRUG DARAP77ERNALIA TRK#: ZLAOOJ9102 COURT DISPOSITION AGENCY: IA032015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA124.414 POSSESSION OF DRUO PARAPRERNALIA COURT CABS ID: 06521 SMSM090252 CHARGE CLASS: MISDEMEANOR CONVICTION TRW IAOOJ9102 SENTENCE PINE $100 GCI 00706142 MOE 2 OF 2 DISP Epp DAT 20080925 20080925 200&0925 DISP EFF DAT 20141024 AN ARREST WITHOUT DISPOSITION IS NOT, AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRI14INAL INVE9TIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD SUT CAN ONLY BE RELEASED TO NON—LAW ENFORCEMENT AGENCIES BY THE ACI. IN TRE ABSENCE OF FINGERPRINTS FOR POSITIVE IOENTIFI CATION THIS RECORD IS BASED ON INFORMATION FURNISHED, NE CANNOT CONFIRM OR DENY THAT TRE RECORD COVERS THE SUE3'ECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION a Z0003/0003 N0. 2894 P. 5/6