The URL can be used to link to this page

Home My WebLink About16-179' l 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. l(� —79' (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 1. Name (REQUIRED) 2. Address (REQUIRED) 01 3. Contact Information (REQUIRED) Email: (All written comm 4a. Driver's License expiration date (REQUIRED) 2' b. Taxicab Business Name (REQUIRED) �2 ✓ L� 5. Prior experience in transportation of passengers: Phone: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When f7 What happened to the charge? (Circle one) Convicted Dismissed eferre Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Vitt Type of offense Where When What'happened toihe char? Circle one) onvlcted Dismissed Deferred Suspended Plead Guilty Other 1 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When c, r- 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please,provjde tti's name(Is A)� - r, a �-.. i -- DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED ' DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF$EVIEIN , You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereve issued to me by the low pa ment of Transport io a alid Driver's license number issued on�expiring on I understand that if I falsely answer any questions in this application, that this a lice on may be denied. I ree hat in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to xamine any and all records and documents relating to this application, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant o" L' u(L Date_ STATE OF IOWA ) COUNTY OF JOHNSON scribed and sworn to before me by r I Yy(1 "e, i t 1 t S on this )S day of �O L KELLIE K. FRUEHU O �, L commissar 4uff0w s?ie t Public in and for WA State of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license �l C, Signature of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signature of City Clerk or designee Approved application DCI report State certified driving record Website update i Date N r-� Ma$ Office Use Only c �` rJ .... r� Cler AXIDRIVBADCEAPPL92014emended.DOC 07/2016 Aug. 19. 1U1b 11:2dAM Div of Criminal Investigation 010/16/2015 ,6:,No. 106531 P. x3/48 ops S'FATE OF, l[OVVA Criminal History Record Check X 0:1 Request 1ForM, To: Iowa Division of Criminal Investigation Support Operxtions Bureau I"Floor 215 B. 7" Street Des Moines, Iowa 50319 (515) 725-6066 (515) 725.6080 Fax I am requesting an Iowa Criminal History Record Check on: DCI Account Number: , Y0b Z (if applieable)— From: City of Iowfe CIO City Cleric's Office 4101:. Washia ton Street Iowa City, IA 52240 Phone; 319-356-5041 Fax: 319-356.5497 Last Name (inandater First Nalne (mnnduory) Middle Name (recommended) Date of Birth (mandato `l Gender (mandmary Social Securi /N,-1 ......commended dA'ale emale 3S?" ((/ d ' 152 r Waiver INformation: Wtlhout a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by lave, always nhfain a urnimr Asa... r•.... I.— ac.-rn_- _ Waiver Release: f hereby giva prnnission for die above requesting official ro conduct an Io,ra crimind hislory sccard check with ncc oh'ision otCfinlinal Invotigalion(M). Any criminal hismry data eone9"18 me l)q is maintained bylhc logl MayAtycitned as ailowrd by law. uwa_Criminal History Record Check Results As of __ZA104 , a search of the provided name and date of birth revealed: 13 No Iowa Criminal History Record found with DCT Iowa Criminal History Record attached, DCI 4101 DCI initials 4o DCI -77 (00/25/10) Received Time Aug. 16. 2016 3:58PM No. 182 (DCIrm only) - <_E �s tV v ry r• ; Aug,19, 2016 11;28AM Diu of Criminal Investigation IOWA CRIMINAL HISTORY / DCT 01013136 COURT DISPOSITION PENDING PAGE 1 OF 1 STATUS UNRNOWN DATE PRINTED - DCI :01013136 2016/08/19 NAME: WILLIS,ANDREA LOLITA DOB SEX RAC HGT WGT EYE HAIR SIN POB 19800829 F H 502 150 SRO BLK LER IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE; Y TAT CHEST TAT R ARM TAT R THGH CCH RECORD •++ 01 ARRESTED 20141003 No. 1065 P. 4/4 AGENCY: XA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA715A.8(3)-A IDENTITY THBFT TRK#: 1A00JXL01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA715A.0(3) IDENTITY THEFT UNDER $1,000 -- Forgery COURT CASE ID: 06521 FECRIO6625 TRK#; 1A00JXL01 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT VICTIM RESTITUTION PAID 20151005 PROBATION lY 20151005 02 ARRESTED 20150810 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA715A.5 TAMPERING WITH RECORDS - 1987 TRK#: 5AOOR3NOI COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA715A.5 TAMPERING WITH RECORDS COURT CASE ID; 06571 AGCRI13832 TRK#: 5A00R3N01 ^� o_ SENTENCE DISP EFF DAT rn DEFERRED JUDGEMENT 1Y 20160225 C PROBATION lY 20160225 G� 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 fN ENFORCEMENT AGENCIES BY THE PCI. - N IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS r.� BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION I1 ~1� �,IOWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.lowadot.gov Office of Driver Services PO Box 9204 1 Des Moines, IA 503069204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www.iowado[.gov Inquiry 8/31/2016 Date: Customer #: 4685633 Name: Willis, Andrea Lolita Address: 2219 11TH ST City/State: CORALVILLE, IA 522411368 Mailing 2219 11TH ST Address: Mailing CORALVILLE, IA City/State: 522411368 Date of 8/29/1980 Birth: Sex: F Convictions Certified Abstract of Driving Record DL/ID #: 181AD9000 (IA) CDL Permit Class: None Class: B CDL Permit Issue Explanation County Date: Audit #: 7293771 CDL Permit Speed Johnson Expiration Date: Issue Date: 08/29/2013 CDL Permit Speed Johnson Endorsements: Expiration 08/29/2018 CDL Permit Date: Johnson Restrictions: Endorsements: PS ID Status: Restrictions: NONE OL Status: Restriction None CDL Status: Supplement: CDL Permit Status: CDL Cert Status: History Information CDL Med Status: None None None None None VAL VAL ELG Excepted Interstate None Citation Date Conviction Date ACD Explanation County JUR 05/25/2012 07/23/2012 S92 Speed Johnson IA 11/24/2014 01/04/2015 S93 Speed Johnson IA 02/06/2015 06/04/2015 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Willis, Andrea Lolita DL/ID: 181AD9000 Pursuant to Iowa Code 4321.10, 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. N O In witness whereof, I have caused my signature and the seal of the Department to be set upon this docunlgZ, at Ankeny, Iowa this date: 1 m W t 4��1 8/31/2016 hi®ester Officea Departme tServices ir Transportation ansportation Name: Willis, Andrea Lolita DL/ID: 181AD9000