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HomeMy WebLinkAbout16-085rlll� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 3 56-549 7 FAX IDENTIFICATION NO. / U `D F, S (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 First Middle Last 1. Name (REQUIRED) __�QbP-T 2. Address (REQUIRED) /3 3. Contact Information (REQUIRED) Email: r,;'� el4el-l:z C 6!.,(weJ.cr,_CeIIPhone:3%9--3SU-7S7/ (All written communications nt via email) ' 4a. Chauffeur's License expiration date (REQUIRED) .7c-!�_ C?0,,2/ b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation /ofpassengers:A,%, PXnrvr`rares � `:�r ,1Qc�rrr_� /S �ptrf> �P rv� lJlvls'v /Lj�„��/�v 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?� Type of offense Where When vvnat nappenea to the cnarge! (Arae one) Convicted Dismissed Deferred Suspended Plead Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When E CJS 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the niame(s) n/n a DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFI% DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REyJEW You must apply for an individual Department of Criminal Investigation Report (form available upon -request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 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 .?1><_.4F536? issued on 2-a6-iY expiring on 7-/s`^2/ . 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—� i pct �i- Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by-gx�ld -ef-L Al 17 iD i tZ on this Z'r- day of A-": 1 7 -mil. 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 V6 t/ � UL Signat re ice Chief or designee L011.0 A 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. 7�l d Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ClerkRAXIDRIVBADGE PPL92014amended.DOC `flZ- _7-//C ate iuvlL,LIlllclo ulv of lminal !nvtsIlgafn oairei�or� ,a;6No2191G.r 9/12 00, Criltlinat His4ory Rev:o.l-d Check Request �e To: 301va 4ivislon of CG-iraioal InvevIlgatioa guppnrl Operations Bureau, E 1, zlor" 115 U. '>la Street ❑es Moines, lava 50319 (575) 725-6066 (515) 72s"-6080 Fax �ec,b-,-p/ DCl/lccoun1lVurober:, (ifapplicable) --� F'rolao Cif oFlowa Cify City Clerk's Offcce "--- AIO C. 1§'aahlni<tu11 9tree`--� --� YorySIGly, lA 52240 -- � Phone: rax: 319-35�� 7 ---- ""c 1, numDer recommcn0e ale (]Female IR7-,/G^ S(n3 e rel erablk, tR[iarf_ tVfthoat a signed waiver from the sop)oet of the request, a complete criminal history record may not he releasable, per Code of lolva, Chapter 692 ,2, For ca`� criminal history record mPle a er"'l, as allowed bylaw, ah), No obtain a walver sl nature from the snbject of tltc request, ys 11'aiver Rele¢se: r hereb • c Penh ission for the a w lm'erligalian(DCI). Any viminell i5lDry dale Concern;".9 e"A`5rlllg o[rcial to con duel an fbe a criminal blslary record check witll IAc Division Or Criminal 3 [hat is maimained by the DCl may Dc released a5 allowed bylaw. W(riverSignatore ov�'aF ieeli7lalistor urea ��leclt8e�u[t-'°— As of G% /9 Ncr tlr um3l of the provided name and date of birth revt�led ® No lom Criminal History Record finnzd with I?C] n i w Ti layaaCaiminal I-lisloryRerord attached DCII lel initials ---`-- _V Received Time Apr, 18. 2016 2:41PM No -2541 nPr, Iti' zuio 12:z3' IV, uiv Ot GrIm,oaI lovesti@atioo No.2191 P, 10/12 DCI :00421716 NAME: BOLTZ,ROBERT BOLTZ,ROBERT ADAM DOB SER RAC 19580715 M W ADDITIONAL IDENTIFIERS TAT L SHLD TAT UL ARM 01 ARRESTED 19910629 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI 00421716 PAGE 1 OF 3 DATE PRINTED - 2016/04/19 HGT WGT EYE HAIR SKN POE 510 190 BLU PRO FAR PA CCH RECORD *** AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA236-2-2A ASSLT CAUSE INJ DOMESTIC TRK#: L39988701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA236-12 ASSAULT CAUSE INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39988701 RESTITUTION SENTENCE JAIL 45D PROBATION ly SUSPENDED 225D BATTER£RS AND SUBS APUSE TRTMNT 02 ARRESTED 19911018 AGENCY: IA0520000 JOHNSON CO 50 CHARGE NO- O1 IA STATUTE IA236-11 VIOL NO CONTACT ORDER TRK#: L39988801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- Ol IA STATUTE: IA236-11 VIOLATION NO CONTACT ORDER CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L399688ol SENTENCE JAIL 35D COURT COSTS 5D CREDIT FOR TIME 03 ARRESTED 19911122 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- O1 IA STATUTE IA321J-2 OWI IST TRK#: L39988901 DI2P EFF DAT 19911021 19911011 19911011 DIS$ EFF DAT r..' t� 19911022 19911022 —A 0 npr,, iY. a I[.[3rivi uiv of GriminaI Investigation No, 2191 N. 11,112 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA221J-2 OWY-2ND OFF CHARGE CLASS: MISDEMEANOR CONVICTION TRY.'#: L39960901 SENTENCE JAIL 36013 DL PARRED 6Y -PAID SURCHRG FINE $750 04 ARR98TED 19920116 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 02 IA STATUTE IA708-2-2 -2-ASSAULT CAUSE INJURY TRK#: L39969002 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: SA706-2-2 ASSAULT CAUSE INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39989001 SENTENCE JAIL 1201) 115D CREDIT 05 ARRESTED 19920116 A AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA702-16 WILLFUL INJURY TRK#: L39909101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO LIST COURT COUNT NO- 01 IA STATUTES 1A706-2 ASSAULT WITH INT TO INFLICT SERIOUS INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L29989101 SENTENCE PLEAD GUILTY 115D CREDIT JAIL 360D 06 ARRESTED 19920705 AGENCY IA052020o IOWA CITY PO CHARGE NO- 01 IA STATUTE IA321A-32 DRIVE W/REVOKED TRK#: L39969201 COURT DISPOSITION AGENCY: IA05201E,T JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321-210 DCI 00421716 PAGE 2 OF 3 DISP EFF DAT 19920508 19920508 DISP EFP DAT 19920508 DISP EFF DAT 19920506 19920508 ++p,. iY [UID I2I14rNl U I V OT �Ylnitnai lnvesTi@a[icn DCI 00421716 PACE 3 OF 3 DRIVING WHILE RVKD CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39989201 SENTENCE DISP EFF DAT FINE $50 19921.007 PAY SURCHRG 07 ARRESTED 19971007 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 FOSS SCHED I TRK#: 037284301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401(5) FOSS CONTR SUBS-SCH I-HARIJ CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 0372B001 SENTENCE DISP EFF DAT FINE $300 19980114 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION I$ A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THT5 RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OP YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION m m e a 3 C a' UI N 0 m 6 m co 40 O b , -Oi= m � n � w a m D 3 O w 0 W �' r W O O m w 3 .�- > ➢ p D � o \ p p O= N 3 W N N d RT+ n i a �vmid m m m o o rtb n C m m X a Or d 0 N C N m w —t m n n C Orn w = a <- a A emi z n w o o .� p w a ° `w < 0p C O O r V r N p o A to N a O !^ H '11 m r O T M A 0 m D A d n G p n O w ! N p a n O :3 to N W rr <� cs CO O a nnv�mm�°nnn ° O r° O n 0`�o:I© < N a r r r r g T r o m r d 0 r O r v r w w pol a co rn Iii En an d m R y^ M T m m m co m m W S YJ 0 o aC 3 C N H m 3 3 O W o m V A V N N n "n d C N C N '� m m N N % 9 N C 0 cm H A z z m z< m z z z z z 0 0 0 o r o L7 D X o 0 0 0 o u � d _ Q � m m M d 0 c o 9a O b N R � n cz < m