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Home My WebLink About16-178� r CITY OF IOWA CITY 410 East Washington St reel Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319)356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 11-o-1-7 (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 e 2. Address (REQUIRED) SG I {MP t 4 L,A/ TOwN � (LY , 5�1 tno�, n,� 3. Contact Information (REQUIRED) Email: qji fhorty -cry 7.2otD 0gwla, I Cell Phone: C3/SJ 6-21' (All written corhmurfication sent is email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 20l 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? �l Type of offense Ipp3SP)ion of (, What happened to the charge? (Circle one) Where When .?607 2ODS , 1100r Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? WO Type of offense What happened to the charge? (Circle one) W here --t(>n.a 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 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please Kovide t4namgLt Ca DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED' DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF itEVIEW ,; 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 herebyy certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number gOS 2z yi9�issued on e441; expiring an d/ (S . 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 Date 9-$/-/ -3l`/ /11/� llrt_� !f H1tHYH#HHH1Y4f 11f lHt1HHHHH+f f ###YY#11Hf1fl11flf flflflflflHttH'!##Hflf f!!f fllllf HHI+#f YHf#HiY�#fYff 1HHHlH1ff11H1f 1f-I!H STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed ad sworn to before me by Rrvd��i �. Q o�6 n i. tP 7 1 on this 5day of A. _.. G A- -7 , j i " 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 Driver's license Signature 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. Aae.�Z") k ,2.�.!% of City Clerk or designee 7131 Z; -P ate N O Q# 1fH1H1HHflfHHlffHf+'lfflHlff fffHHfffllf+flHHffffff 1f ffHIH+HffHIfHHH#-H'f f flfYffHHf f� 1 Office Use Only 7- = w Approved application DCI report State certified driving record Website update Oen✓ AXIDRivenoceAPPLsmia,�dm.00c 07/2016 oeiAug. 19 2016111:25AMCeb Div ofNo.1063 V�riminaI Investigation (FAX)31933e2iu STATE . IOWA L,Criminal History Record Check Request Form Tot Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 215 E. T" Street lies Moines, Iowa 50319 (515) 72S-6066 (515)725.6080 Fox I am requesting an Iowa Criminal History Record Check on: P'v . uov 002 tr, L •);;r'sm DCI A000unt Numbar: . 9967-F (Ireppliceble) From Yellow Cab of Iowa City P.O. Bax 428 Iowa Clty, IA. 52244 (319)338-9777 Phone! Fnxl (319)339-7302 Last Norma (niandgo First Name (mandatory), Middle Name ocoommendoo 17 0 (i A-6 o), Data of Birth (mmdatory) Gender mandelo 'Social•Securl Numbor neommendtd a g 'RMale MFOmale 0-5y- 6967 Walver it v/ marlon: Without a signed waiver from the subject of the request, a eomplgto orlminal history record may not be releesable, per Code of Iowa, Chapter 692.2, For e9=16io eriminal history -record information, as allowed by taw, always obtain a waiver signature from the subject of the request. Walver Release: I hereby give permisslon for the above requesting omelet ro condudt an fovm crlminel hlaoty record check with the Dlvlslen of criminal Investlgetion (DCO. My criminal hhlory data concerning me that Is molmolned b0e DCI maybe rcleutd u allowoll by law. Waiver Signature: As of—? / l �, a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCI # 7�o sea DCI initials _ 42 DCI -77 (08/25/10) Received Time Aug. 17. 2016 9:24AM No. 1865 (DCf use only) rat Aug.19, 2016 11:26AM Div of Criminal Investigation ADDITIONAL IDENTIFIERS TAT R ARM TAT R WRST CCH RECORD **- 01 ARRESTED 20031024 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401(5) POSSESS CONTROLLBD SUBSTANCE I/ W/INTENT TRK#: 100990101 CHARGE NO- 02 IA STATUTE IA321-561 DRIVING WHILE BARRED TRK#: 100990102 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 PECRO66855 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100990101 LICENSE REVOKED SENTENCE JAIL 20 FINE $250 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 FECRO66855 CHARGE CLASS: MISDEMEANOR CONVICTION TRK$: 100990102 SENTENCE JAIL 16D FINE $500 02 ARRESTED 20050102 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVING W/BARRED TRK#t 101394301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 DISP EFF DAT 20040123 20040123 DISP EFF DAT 20040123 20040123 No. 1063 P. 3 G IOWA CRIMINAL HISTORY DCI 00710502 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2016/08/19 DCI:00710502 NAME: RODRIGUBZ,ANTRONY RAY DOB SEX RAC HGT WGT EYE HAIR SKN POB 19810728 M U 600 195 SRO ELK TX ADDITIONAL IDENTIFIERS TAT R ARM TAT R WRST CCH RECORD **- 01 ARRESTED 20031024 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401(5) POSSESS CONTROLLBD SUBSTANCE I/ W/INTENT TRK#: 100990101 CHARGE NO- 02 IA STATUTE IA321-561 DRIVING WHILE BARRED TRK#: 100990102 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 PECRO66855 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100990101 LICENSE REVOKED SENTENCE JAIL 20 FINE $250 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 FECRO66855 CHARGE CLASS: MISDEMEANOR CONVICTION TRK$: 100990102 SENTENCE JAIL 16D FINE $500 02 ARRESTED 20050102 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVING W/BARRED TRK#t 101394301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 DISP EFF DAT 20040123 20040123 DISP EFF DAT 20040123 20040123 No. 1063 P. 3 G Aug -19. 2016 11:26AM Div of Criminal Investigation No.1063 P. 4 DCI 00710502 PAGE 2 OF 2 COURT CASE ID• 06521 AGCR071053 CHARGE CLASS: MISDEMEANOR CONVICTION TRM 101394301 SENTENCE DISP EFF DAT JAIL 10D 20050314 FINE $500 20050314 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 eV o_ CT qq Aug.19. 2016 11:26AM Div of Criminal Investigation COURT CASE ID• 06521 AGCR073053 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101394301 SENTENCE JAIL XOD FINE $S00 DCT 00710502 PAGE 2 OF 2 DISP EFF DAT 20050314 20050314 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 ENFORCNmXNT AGBNCIBS IsY 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 I No. 1063 P. 4 CIowa Department of Transportation AW Office of Omer Servfces (Toll Free) BOD -532.1121 PO Box 9204, Des Manes, L0. 50306-9204 515-244-9124 FAX- 515.239.1837 History Information Convictions Citation Date Conviction Date Certified Abstract of Driving Record Ex lanation Inquiry Date: 8/16/2016 DL/ID 4: 803ZZ4292 (IA) Customer u: 5077845 Name: Rodriguez, Anthony Class: C ID Status: None Ray Address: 501 MINERAL POINT Audit n: 7315847 DL Status: VAL LN Issue Date: 09/06/2013 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 07/28/2018 CDL Cert Status: None 522466105 Endorsements: NONE CDL Med Status: None Mailing Address: 501 MINERAL POINT Restrictions: Corrective Lenses Restriction None LN Supplement: Date of Birth: 7/28/1981 Mailing IOWA CITY, IA Sex: M City/State: 522466105 History Information Convictions Citation Date Conviction Date ACD Ex lanation lCounty JUR 105/05/7013 106/04/2013 1 B64 No Insurance Card Johnson IIA Name: Rodriguez, Anthony Ray DL/ID: 803ZZ4292 Pursuant to Iowa Code 4321.10, I, Melissa Splegel, 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: IOWA D. 0. T. Name: Rodriguez, Anthony Ray DL/ID: 803ZZ4292 i 8/16/2016 i ��r/I �/tf f f -- a = s Office of Driver Services Iowa Department of Transporation t