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HomeMy WebLinkAbout16-165IDENTIFICATION NO. I ' r I (Office Use Only) Nit?' 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 (3 19) 356-5040 (319)356-5497 FAX 1. Name (REQUIRED) 1C00(4C V lead &� 14iil- 2. Address (REQUIRED) o 2- �v k e Ife � � �oWa- C,14-4 Tot, Aa 5;2-2-W 3. Contact Information (REQUIRED) Email: 1'bd Z) ((ALG @uLoo. Co�Cell Phone: (All written commun`i tion sent via email) � 4a. Driver's License expiration date (REQUIRED) - 7I • ;1D,26) b. Taxicab Business Name (REQUIRED) _ Ye abl.) C� owa- Gi 5. Prior experience in transportation of passengers: _� �� lie d i- ve^ 401' )ie l/oW Gab a,iC Iowa Ci±.x &r S 1par5. 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offenseW here When TA ff 2nd deyr<P C40 cff f rT.lc9lc� I What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When 5(ed +l(;no1 S 2•.28-20/z 5Leej 1"Q wa, 6 - 5 A0/,2 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty ! OthW[. 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Tvoe of offense Where 1- When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the rlame(s) 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 9�QyQf{ `jd'67 issued on 2 -IA -)415 expiring on 3-5 -.2oRo . 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 �DC A t *__ 'P. Date 8-,Z_5 -,2616 01 ++»+a+x+++a+aaaaa+++araraaaa+aa+a++x+x++aaaaaaaaaaara++aa+xxxax+aa+++aaaaa+aa+aaaaaaaaa++aaaxaxxxaa+aarrrwawa+rra«+aaa+axaaaxx+xaaaaaaaaaara» STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1,4n ­ip . ?4 IcLZT on this Z day of As:�sir- Z01 LQ \ f % Public irond for the State of Iowa 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). Expiratio date of Driver's license �S i 2 �2 U y,/ 2 Signa of Po ice Chief or designee I 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. 2q.rsAr , ci 1C - CLW SignMure of City Clerk or designee Dat a+aaa+++aaaaaaaaaaaaaaaaaaaaaaaa+aaaaaraar+aaa++a+aaa:aaa+aaaaaa++aa+aaaaaaaa+aaaaaaaaa+aaraaaaa+aaaa+aaa+++++aaaarx+�aar+aa+a++a+raaaaaa+++++ rn Office Use Only . r� Approved application DCI report d `� State certified driving record o !� Website update w c> Clink TAX1DRN64DGFAPPOW1�.DDC 07=16 CIowa Department of Transportation OBioe of Dliver Serw;es (Toll Free) OW -532-1121 Pb ®mi SM, Dos Mdnes, K 503DG92D4 515.244.9124 FAX -615-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/23/2016 DL/ID #: Name: Blair, Rodney Dean Class: Address: 602 FOX TRL Audit #: 02/12/2015 CDL Status: Issue Date: City/State: IOWA CITY, IA Expiration Date: Wearing corrective lenses 522409209 Interstate L CDL Med Status: Endorsements: Mailing Address: 602 FOX TRL Restrictions: Supplement: Date of Birth: Mailing IOWA CITY, IA Sex: City/State: 522409209 CDL Medical Examiner's Certificate 960AA9807 (IA) Customer #: 2228817 B ID Status: None 8838470 DL Status: VAL 02/12/2015 CDL Status: VAL 03/05/2020 CDL Cert Status: Non -Excepted Wearing corrective lenses Medical Certificate Issued Date Interstate L CDL Med Status: Certified NONE Restriction None Supplement: 3/5/1966 M Certificate Specifics Explanations Medical Examiner First Name Krista Medical Examiner Last Name Ford Medical Examiner License Number A116969 Medical Examiner National Registry Number 3880330225 Medical Examiner Jurisdiction IA Medical Examiner Phone 319 337-9066 Medical Certificate Restriction 1 Wearing corrective lenses Medical Certificate Issued Date 01/16/2015 Medical Certificate Expiration Date 01/16/2017 Date Added to CDLIS Driving Record 01/16/2015 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11114/2011 12/07/2011 S92 Speed Johnson IA 01/08/2012 02/28/2012 515 Speed IL 05/3 2016 06/05/2016 592 Speed Pow hiek IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number 3UR 108/20/2007 389515 IA 109/07/2007 392736 IA Name: Blair, Rodney Dean DL/ID: 960AA9807 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: 8/23/2016 10 WA Office of Driver Services Iowa Department of Transporation Name: Blair, Rodney Dean DL/ID: 960AA9807 08/Aug. 17. 20163. 9:45AMCeb Div of Criminal Investigation (Fax)31933e2No.0758 STAtE OF • Criminal History1 1 1;• To. low& DIVIelon of Criminal Investigation Support Oporatlons Bureau, 111 Floor 216E. 11" Street Des Moines, Iowa 80319 (515)725.6066 (816) 726.6080 Fox I em reauestine an Iowa Criminal History Record Check on: P. .1/6/002 DCIAaaountNumber. • 9967•F ' t• �llflppllceblo) Frcmr Yellow Cab of town Gty . P.O, Box 428 Iowa City, IA. 52244 (319) 338-9777 rhonol Fax, (s19) 339-7302 Last Name mandate FirstName(mandat • Middib Name rerammanded 1314ir Date of Birth mvismo Gender mandato 5oefal eaurjp Number pecammeadea 3 wale ©itemale' Waiver,rgArmaflon:.Without a signed waiver from the subject of the roquest, a. complgto grlminal history record may not be releasable, per Code arlowa, Chapter 6912, For complato criminal hlstory.reeor(1 Information, as allowed by low, always obtain a waiver sl nature front lire sub act of the request. Wailer Release; I hereby give pvmiulon (or The above raquesitng omelal 10 conduct M Iowa criminal hrnoly record check with the Division otCrlminal Invosilptloe (DCI). Any griminal history aisle conc/ming me that Is maintained by the DCI may be lalsaled as allowed by Jaw. Waiver Signature: �djw'- As ofla; a search of the provided name and date of birth ravaaled: ❑ No Iowa Criminal history Record found with DCT r �= Iowa Criminal History Reiiord attached, DCI # Ti c�. DCI initials cern DCI -77 (08/25/10) Received Time Aug -ll, 2016 3:47PM No -0358 Aug.17. 2016 9:45AM Div of Criminal Investigation DCI:00316955 NAMES BLAIR,ROD BLAIR,RODHEY DEAN DOB SER RAC 19660305 M W ADDITIONAL IDENTIFIERS SC R WRIST SC UL ARM IOWA CRIMINAL HISTORY DCI 00316955 FELONY CONVICTION PAGE 1 OF 5 DATE PRINTED - 2016/08/17 MGT WGT EYE HAIR Sm POE 601 278 HA2 BRO MED IA CCH RECORD *** O1 ARRESTED 19040401 AGENCY; YA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA715-1-6 BLS USE FIN INBTR 2ND TRK#: L25803001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA715-1-6 FLS USE FIN INSTR 2ND CHARGE CLASS; STATUS UNKNOWN TRK#: L25803001 SENTENCE JAIL 11D 02 ARRESTED 19040530 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND TRK#: L25803101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: OPERATE MOTOR VEHICLE W/OUT OWNER CONSENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L25003101 SENTENCE PLEAD GUILTY JAIL 72D 03 ARRESTED 19950625 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2-5 THEFT STH DEG TRK#: L25803201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-2-5 THEFT 5TH DEG CHARGE CLASS; MISDEMEANOR CONVICTION DISP EFF DAT 19840412 DISP EFF DAT 19840822 19840822 No -0758 P. 2/6 Aug -17. 2016 9:45AM Div of Criminal Investigation DCI 00316955 PAGE 2 OF 5 TRK#: L25803201 SENTENCE DISP EFF DAT PLEAD GUILTY 19850708 FINE $100 19850708 04 ARRESTED 19550725 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA713-5 BURG 2ND DEG TRK#: L25803301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTEe THEFT 4TH CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L25803301 RESTITUTION SENTENCE DISP EFF DAT PROBATION lY 19851002 SUSPENDED 90D 19851002 05 ARRESTED 19860320 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND DEG TRK#: L25802401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO. 01 IA STATUTE: IA714-2-2 THEFT 2ND CHARGE CLASS: FELONY CONVICTION TRK#: L25803401 SENTENCE DISP EFF DAT PROBATION 5Y 19870129 CREDIT 22D 06 ARRESTED 19860610 AGENCY: TA0520200 CHARGE NO- 01 THEFT 2ND bEG TRK#: L25803501 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 IOWA CITY PD IA STATUTE IA714-1-3 JOHNSON CO DIST COURT IA STATUTE: IA714-1-3 THEFT 2ND DEG CHARGE CLASS: FELONY CONVICTION TRK#: L25803501 No. 0756 P. 3/6 Aug.17. 2016 9:45AM Div of Criminal Investigation RESTITUTION SENTENCE PROBATION 5Y 07 ARRESTED 19870107 AGENCY; IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA708-4 WILLFUL INJURY TRK#: L25603601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: TERRORISM CHARGE CLASS: FELONY CONVICTION TRK#: L25803601 RESTITUTION SENTENCE CONCURRENT W/CYCLE DOA 06/10/86 PROBATION SY 08 RECEIVED 19870129 AGENCY: IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND TRK#: 1,25803701 INMATE #: 803150 CHARGE NO- 02 IA STATUTE IA714-2-4 THEFT 4TH TRK#; L25903702 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; I4714-2-2 THEFT 2ND CHARGE CLASS: FELONY CONVICTION TRK#: L25803701 SENTENCE PROBATION 5Y COURT DISPOSITION AGENCY: IA052025J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714-2-4 THEFT 4TH CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L25803702 SENTENCE CONSECUTIVE SENTENCE WITH CT 01 JAIL 90D COURT DISPOSITION AGENCY: DCI 00316955 PAGE 3 OF 5 FISP EFF DAT 19570129 DISP EFF DAT 19870226 19570226 DISP EPP 'DAT 19870129 DISP EFF DAT 19870129 19870129 No.0756 P. 4/6 Aug -17. 2016 9:46AM Div of Criminal Investigation IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: TERRORISM CHARGE CLASS: FELONY CONVICTION TRK#; L29803103 SENTENCE JAIL 5Y CONCURRENT WITH CT 01 & 02 CUSTODY AGENCY? IAOS3016C ANAMOSA MENS REFTY A 19870226 RELEASED BY COURT ORDER CUSTODY AGENCY: IA053015C ANAMOSA MENS REFTY B 19870226 RECEIVED RETD ON COURT ORDER CUSTODY AGENCY: IA077015G ADULT PAROLE SVC C 19880302 PAROLED CUSTODY AGENCY: IA052015M OAKD"E IMCC D 19881208 PAROLE REVOKED CUSTODY AGENCY: IA077015G ADULT PAROLE SVC E 19090510 PAROLED CUSTODY AGENCY: IA0770150 ADULT PAROLE SVC F 19890831 DISCHARGED FROM CRIMINAL JUSTICE SYSTEM 09 ARRESTED 19061116 AGENCY: IA0520000 CHARGE NO- 01 PAROLE VIOLATION TRK#: L25803801 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 JOHNSON CO SO IA STATUTE IA906-1 JOHNSON'CO DIST COURT IA STATUTE: IA906-1 PAROLE VIOLATION CHARGE CLASS: FELONY CONVICTION TRK#: L25003801 SENTENCE TO SERVE DAL 06/10/86 10 ARRESTED 19901102 AGENCY: IA0520200 CHARGE NO. 01 THEFT 1ST TRK#; L25803901 COURT DISPOSITION IOWA CITY PD IA STATUTE IA714-1-6 PCS 00316955 PAGE 4 OF 5 DISP EFF DAT 19870226 19870226 DISP EFF DAT 19900703 No. 0758 P. 5/6 Aug.17. 2016 9:46AM Div of Criminal Investigation No.0758 P. 6/6 AGENCY; IA052015J COUNT NO- 01 JOHNSON CO DXST COURT IA STATUTE; IA714-2-1 THEFT IST CHARGE CLASS; FELONY CONVICTION TRK#i L25803901 SENTENCE JAIL l0Y 21) CREDIT 11 RECEIVED 19910913 AGENCY; IA052015M CHARGE NO- 01 THEFT IST TRK#: L2$804001 COURT DISPOSITION AGENCY:' IA052015J COUNT NO- 01 OAKDALE IMCC IA STATUTE IA714-2-1 INMATE #: 803150 JOHNSON CO DIST COURT IA STATUTE: IA714-2-1 THEFT IST CHARGE CLASS; FELONY CONVICTION TRK#: L25804001 SENTENCE JAIL SOY CUSTODY AGENCY; IA077015G ADULT PAROLE SVC A 19940714 PAROLED CUSTODY AGENCY: IA0770150 ADULT PAROLE SVC B 19960714 DISCHARGED FROM CRIMINAL JUSTICE SYSTEM DCI 00316955 PAGE 5 OF 5 DISP EFF DAT 19910912 DISP EFF DAT 19910913 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. IN 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 INQUIRY. DIVISION OF CRIMINAL INVESTIGATION �1