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Home My WebLink About17-0021 i� 'r M1W®��11 CITY OF IOWA CITY 410 East Washington Slrect Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. / -7 —Q��_ (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 Middle 2. Address (REQUIRED) U0 t, Dl nab A 75,1 Z'Dwq ciTy. q4 S YU 3. Contact Information (REQUIRED) Email: leSooE,QR (Z'A6 A V071mr, coM Cell Phone: 314- 411-364 7— (All written communicatch sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 1201 L'j_'i b. Taxicab Business Name (REQUIRED) jCjj0%.J (--" 5. Prior experience in transportation of passengers V P4. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? h 0 Type of offense Where When 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? 00 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? V14 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 ngme(s) . r� 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) 02/2015 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 cNAY F�co(�ofZ issued on cL(n�1��expiring on ILI2y73 . . I understand that if I falsely answer any questions in this application, that this applicafion 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 ApplicantXq�.,✓ Date ) 4e l 1b STATE OF IOWA ) COUNTY OF JOHNSON ) p Subscribed and sworn to before me by L 5 Ar, F 0% , on this I day of "1 n r A.A.a 6 � 7011 0 I have reviewed this application. DCI report, and the State certified driving record of this applicant and have determinPad that there is no informa6on which would indicate that the issuance would be detrimental to the safety, health or welfare 6'r r2si- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license Signature of Police Chief or designee Z12 -w2 z� 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. SiginaWre of City Clbrk or de gnee Date 411###*#**f#F###+##***t*R}**R!f*R+RR*#*******f*RffR1}*ff**tff*1**1Yf1R111ffftR1f1111f1f1RR1f#tf4ff4f4ff*#41##'k##44**#R*R*##*******f RR*f1Rf1f1f4f Office Use Only Approved application DCI report State certified driving record Website update CWWrAXiDRJ D GE PL9=4emer DOC 03/2015 C4610WADOT wwwjowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 55-239-1837 www?iowadot.gov Certified Abstract of Driving Record History Information CLEAR DRIVING RECORD Name: Chay Escobar, Luis Alfonso DL/ID: 555XX6834 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 .arid 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: 11/4/2016 IOWA ......... Office of Driver Services 00-�' Iowa Department of Transportation DL/ID #: 555XX6834 (IA) CDL Permit Class: None Inquiry 11/4/2016 Date: A CDL Permit Issue None Customer 406903 Class: Date: #: Name: Chay Escobar, Luis Audit #: 9688823 CDL Permit Expiration Date: None Address: Alfonso 1206 DIANA ST Issue Date: 01/06/2016 CDL Permit Endorsements: None Expiration 12/24/2023 CDL Permit None Restrictions: IA Date: Endorsements: P ID Status: None City/State: IOWA CIN, 522404629 1206 DIANA 5T Restrictions: CDL ate Only, No DL Status: VAL Mailing Class A Passenger Address: Vehicle Restriction None CDL Status: VAL Supplement: CDL Permit ELG Mailing IOWA CIN, IA Status: City/State: 522404629 CDL Cert Status: Non -Excepted Intrastate Date of 12/24/1963 Birth: CDL Med Status: None Sex: M History Information CLEAR DRIVING RECORD Name: Chay Escobar, Luis Alfonso DL/ID: 555XX6834 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 .arid 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: 11/4/2016 IOWA ......... Office of Driver Services 00-�' Iowa Department of Transportation v=_• r . LV I V I v, J L n n I v I v v I b l l in l n a l I n v e s t i g a t i o n F/O—C,ty of Iowa oity cierk inti.. 319 3965697 No. M6 Y. 1/1 12/01/2016 17:AG *761 P.001/002 STATEGFIDWA C11`iinina; History Record ClIeck Request Fori'I 'fo: Iowa DIVISIon of Criminal Dtvest(gation 'Support Operaliona liuruau, I" Fluor 215 r. 7",Weet Iles Moines, lona 50319 (51.5)723-6066 (51$)')1,-"1.6080 FaX--, - Nante SCO 20 (33 on: er DCJ Account Number: (if epplicnhle) From: Cts of IPWa Cftr• _ City Clet•Jc'e Office -- 410 L. WASJdn tma Street Iowa City lA $2240. Phone: 319.356.5041 Fax: 339-356-5497 CWale ❑Female I Witiver 111fol•fftation. Withont 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 coanolete criminal history record Informa(ion, as allowed by law, always obtain a waiver signature from the subieet of the renunct. Waiver Beieate: ) hereby give pemlis, ion for the above fegaesling official Io conduct an IDwa criminal hinory «cord oheck mill she Division of Criminal hwcstigallon(PCO, Any criminal Wlosy data concerninng meIhas is moiniained bytheDClmaybe Icicascd as allowed bylaw. Waiver siortatare: Iowa Criminal History Record Check Results As of _ a search of the provided name and date of birth revealed: 0 10 Iowa Criminal History Record found with I)CI ® Iowa Criminal History Record attached, 1101 11C I initiels�,� _ 1)CJ-77 (08/25/10)----^.�-_^,�- Received Time Dec. 1. 9016 4:31PM No. 9193 (DCI nsa on1r)