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Home My WebLink About16-123IDENTIFICATION NO. f L2.� f z3 b l 1 (Office Use Only) �s I®I��E_ APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX {pFirstdle Last 1. Name (REQUIRED) lv� A b(eL 6 Ci L V"La 2ZCS 2. Address (REQUIRED) 3 S L (c W( S -f"'% s+ 7—j)(W 0 L 1 S Z�(� 6 3. Contact Information (REQUIRED) EmaiC ori?5 2323 -rie Dell Phone: (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIf ED) 72- 0b. I_I Taxicab Business Name (REQUIRED) _ Os - C V6Q r n 5. Prior experience in transportation of passengers: en 10 r r 1(pr2 /,f ' r 3 4 rs 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where Crzmo m l Ty-efs6iss 06, el'IA When 19�� What happened to the charge? (Circle one) d nvi Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Vol Type of offense Where When What happened to the charge? (Circle one) 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? /J 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 -'me(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATECERTIF)t-p DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW - 77 You must apply for an individual Department of Criminal Investigation Report (form available wpo7equest); a (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) n 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certithat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number L 2 1 �, Z- issued on C)5 -3-,q expiring on t2--31-17 1 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 provision /of Title 5� Ch ter 2, of the City Code. (Needs to be'signed in front of a Notary Public) Signature of Applicant t r Date 7 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me byon this �oday of lD 1ktary Mlic in and for thb State o owa n ISO-) 1 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- denFthe'wa C' (Title 5, Chapter 2, City Code).jExpha eur's license 12 ti "l 07m: Sipnatur 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. 2�� -zz zy.r 1C - 7�✓ Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ClerkrrA%IDRIVBADGE PL92014amended. 000 Date k•.: DOT SMARTER I SIMPLER CUSTOMER DRIVEN V WW,jo adot gov Office of Driver Services PO Box 9294 1 Des Moines, IA 60306-9204 Phone _515-244-91241800-532-11211 Fax 515-239-1837 vrxy'.iowadot goy Certified Abstract of Driving Record Inquiry Date: 7/5/2015 DL/ID #: 629ZZ2182 (IA) Customer #: 4335266 Class: D Name: Flores, Miguel Angel Audit #: 8039207 Address: 3826 W 13TH ST Issue Date: 05/03/2014 Expiration Date: 12/31/2017 City/State: DAVENPORT, IA 528044259 Endorsements: 3 Mailing 3826 W 13TH ST Restrictions: NONE Address: CDL Permit Restriction None Mailing DAVENPORT, IA 528044259 Supplement: City/State: Restrictions: Date of Birth: 12/31/1967 DL Status: Sex: M None History Information CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. kccident Date Case Number IUR L212012013 779618 IA Name: Flores, Miguel Angel DL/ID: 629ZZ2182 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: U\11 -"%.- • •�/�4, 7/5/2016 ��f D9�VENSJ Iowa eof Driver Department eoflTeransportation Name: Flores, Miguel Angel DL/ID: 629ZZ2182 - State of Iowa Division of Criminal Investigation 215 E. 7"' Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Cbeck Walk -In Renuest Your name: 1 l)e i�JUeL Address: 3 Y7, (p W j 2>-V" 5+ City/State/Zip: i702tJC_i� r4 Phone #• '�50— 9 Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Name 41,,,11Wo (mandatory) First Name Pnmer Nombre (mandatory) Middle Name sem nd,, u "e.e O, ton rneDded) �C) (o LIE -4 Alb El Date of Birth. FcehalJacr,nlenm (mandatory) Gender Oenero (mandatary) Social Sccurhq Number (recommended) 1A -3 / — C7 7 AMale ❑ Female q7 &(qO V l Waiver Signature Ftrrna(It ineregaestisonyoursch;please sign lrlhereaae=t isottso,neoneetsr..azwn) fill Results u As of `7&A ❑ No record formed a name and date of birth check revealed: [� Record attached DCI # _36-7-7 Sy DCI initials 41 Receipt DCI USE ONLY ON Number of requests _ x $15.00 per last name = Total amount $_5 Method of payment: cash money order check # X7_.5D MasterCard or Visa (Last 4 digits) Cardholder's name i q«�Lej FIor e_s DCI initials _ CAO Credit Card # DCI -83 (09/09/ 10; Revised 10/ l/ 10; form reviewed 08/11/14) Exp. Date C- I> Number of requests _ x $15.00 per last name = Total amount $_5 Method of payment: cash money order check # X7_.5D MasterCard or Visa (Last 4 digits) Cardholder's name i q«�Lej FIor e_s DCI initials _ CAO Credit Card # DCI -83 (09/09/ 10; Revised 10/ l/ 10; form reviewed 08/11/14) Exp. Date Terry E. Branstad Governor Kim Reynolds Lt. Governor July 6, 2016 To Whom It May Concern: Department of Public Safety Roxann M. Ryan Commissioner The Iowa Division of Criminal Investigation believes the attached record is the same individual as the subject of your request. If you feel that these results are in error, you may provide fingerprints for positive identification. Please contact our office at 515-725-6066, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday with any questions or concerns. Thank you, Iowa Division of Criminal Investigation DIVISION OF CRIMINAL INVESTIGATION • 215 EAST 7TH STREET . DES MOINES. IOWA 50319-0041 • 515-725-6010 Integrity, Fairness, Respect, Honesty, Courage, Compassion, Service IOWA CRIMINAL HISTORY DCI 00357754 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2016/07/06 DCI:00357754 NAME: FLORES,MIGUEL ANGEL DOB SEX RAC HIT WGT EYE HAIR 0 11T POS 19681206 M W 509 168 BRO BRO MED NU ADDITIONAL IDENTIFIERS SC L EYE SC R ELB SC RF ARM CCH RECORD *** 01 ARRESTED 19870131 AGENCY: IA0820200 DAVENPORT PD CHARGE NO- 01 IA STATUTE IA321-281 OWI TRK#: L31759901 COURT DISPOSITION AGENCY: IA062015J SCOTT CO DIST COURT COUNT NO- 01 IA STATUTE: IA321-281 OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31759901 SENTENCE DISP EFF DAT PLEAD GUILTY" 19870401 JAIL 2D 19870401 FINE $600 19870401 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. 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. IDI THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR IDIQUIRY, DIVISION OF CRIMINAL INVESTIGATION