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Home My WebLink About17-003CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. ' `Z -t7nZ (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 Last 2. Address (REQUIRED) 21 $ c. r� 5r. /j/ro z PU ✓ X 7 3. Contact Information (REQUIRED) Email:E^xenstcs%)em�� acem66. nEC Cell Phone: d01•210. 9566 (All writte kommunication sent via email) 4a. Driver's License expiration date (REQUIRED) /,2. Oy' -201 b. Taxicab Business Name (REQUIRED) y401. e,6 do /0WA 5. Prior experience in transportation of passengers: AFH jI'd i- -ArRD 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 5077 i« mt to J W, a w ¢Rdv) wce�o u �, Lti MAy 1 r10(o What happened to the charge? (Circle one) / Convic Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? d/b Type of offense What happened to the charge? (Circle one) Where When 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? ^110 Type of offense Where When l}ivtc sl �o rfr /Sloj t/aT L /Wow,, /d AtG. J 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(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 h�?ve sued to me by the Iowa D partment of Transportation valid Driver's license number y 9 ✓Y 0 issued on 4Z/P2D1 expiring on W011-044 1-044 , I understand that if I falsely answer any questions in this application, that tppKiGaflon may be denied. Vagrbe 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 ✓ / STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by T� ONA Q(._ (L- C-d`14tAj) j l.. 7[- on this day of 'I _.-L..e" T TA1-1 T 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#ei s i ense Police Chief -6r designee Dates 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. ctgn��. Clerk�� ee e of City or desig�lee C �\s\\--I Dat Office Use Only Approved application �-, Ln DCI report State certified driving record Website update CIeM MIDRIVBADGEAPPL92014amende .DOC 07/2016 CA Iowa Department of Transportation Office a Drnrea Services PO Bou 8204, Des Man50 es, U► 3068204 (rdt Free) 800332-1121 515.2449124 FAX_ 515239-1837 Inquiry Date: Name: Address: CRv/State: Nailing Address: Nailing City/state: Convictions Certified Abstract of Driving Record 1/4/2017 DL/ID #: Connolly, Robert Class: Raymond JR None 21 Second St Apt 2 Audit #: Restriction Issue Date: Hills, IA 52235 Expiration Date: IA Endorsements: PO BOX 7 Restrictions: 429VV6230 (IA) D 8662133 12/03/2014 12/04/2018 3 Corrective Lenses Date of Birth: 12/4/1959 HILLS, IA Sex: M 522350007 History Information Customer #: 2681075 ID Status: None OL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 1A Citation Date Conviction Date ACD lanation county JUR 09/11/2008 02/05/2009 A20 Operating While Johnson 1A IA Iq Intoxicated 09/09/2009 06/28/2011 A20 Operating While Johnson [A Intoxicated Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Operating While Intoxicated Test Refusal/Test Failure Violations Ourance ACD lanation ]UR 11 2008 A98 OWI Test Failure [q "- 09 09 2009 A98'`- OWI Test Failure 1A Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 09122/2008 03 20/2009 A98 OWI Test Failure IA Iq Name: Connolly, Robert Raymond JR DL/ID: 429VV6230 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: IOWA •:'� D. 0. T Name: Connolly, Robert Raymond JR DL/ID: 429VV6230 1/4/2017 Office of Driver Services Iowa Department of Transporation Drc.30' 2016 8:56AM Div of Criminal Investigation 12/29/2016 11:38Yellou Cab of loka Clty STATE OF Criminal History J e Request I TO; Iowa Division of Criminal investigation Support Operations Bureau, I" Floor 21511, 7i° Street Des Molnes, Iowa 50319 /ale%"49 L"cL 7256080 Fax A No, 0349 P. 1/4 (FA%)3193382709 P.002/002 A d Check, DCI Account Number:. 9967rF (If applloeble) From: Yellow Cab of Iowa City Phone: Fax: /O�Oy///j!9 lSffMale OFemale I yq'. �/ 9133 Walver 4formatlon: Without a signed waiver from the subject o� the request, a complete criminal history record may n6 be releasable, per Code of Xowo, Chapter 692.2, For complete criminal history-reeoro Information, as allowed by law, always Walver Release; I hereby ®Ivo tternthlion stir Iho ahovc ictiucsllno aMcIeIto conduct an lows orlminel hlsloryrecord oheok whit the Olvisian ofCrlminsl Investigation (DCe. any criminal hhtory data eeeeeming me that It maintained by the OCT may be released as allowed by kw. Walper Signature: 0 Town Criminal History Record Ch' ck Results (Dcluto Only) 1 , As of 0 [ a search of the provtdad name and date of birth revealed:. ❑ No Iowa Criminal History Record found with DCT II T� Iowa Criminal History Record attaohed, DCT DCI initials DCT•77 (08/25/10) RcrcivAJ Tema n., 10 IA16 11OAM U (1680 Dee.30* 2016 8:56AM Dlv of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00776527 FELONY CONVICTION PAGE 1 OF 3 DATE PRINTED - 2016/12/30 DCX:00776527 NAME: CONNOLLY,ROBERT RAYMOND CONNOLLY,ROBERT RAYMOND JR DOB SEX RAC NGT WGT EYE HAIR SKN POB 19591204 M W 509 172 BLU BRO NJ ADDITIONAL IDENTIFIERS SC HEAD TAT CHEST TAT UL ARM TAT UR ARM PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20060510 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA708-6 INTIMIDATION W/DANGEROUS WEAPON IRK#: 101868501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.6-2 INTIMIDATION WITH A DANGEROUS WEAPON COURT CASE ID; 06521 FECR076027 CHARGE CLASS: FELONY CONVICTION TRK#: 101866501 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $750 CIVIL PENALTY 20070914 PROBATION 2Y 20070914 SUPERVISED PROBATION TO DCS FINE $750 20090213 SUSPENDED PRISON 5Y 20090213 PRISON 5Y 200902/3 PROBATION UPON 3Y 20090213 REVOCATION OF DEFERRED JUDGMENT REVOKED 20090213 IMPOSED 5Y 20110628 02 ARRESTED 20080911 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF TRK#: IA0053NOI COURT 13ZSPOGITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCR00468D CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA0053NOI No.0349 P. 2/4 Dec.30' 2016 8:57AM Div of Criminal Investigation DCI 00776527 PAGE 2 OF 3 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION RESTITUTION SENTENCE DISP EFF DAT SUSPENDED JAIL 173D 20090205 JAIL 180D 20090205 FINE $1250 20090205 PROBATION 2Y 20090205 IMPOSED 173D 20091201 REVOKED 20110628 20091201 03 ARRESTED 20090909 20110628 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA716.3 CRIMINAL MISCHIEF IST DEGREE - 1976 TRK#; lAO070MOI CHARGE NO- 02 IA STATUTE IA708.4(2) WILLFUL INJURY - CAUSING BODILY INJURY TRK#; 1A0070M02 CHARGE NO- 04 IA STATUTE IA321J.2(B) OPER VER WH TNT (OWI) / 2ND OFF TRK#: 1A007OM04 DISP EFF DAT COURT DISPOSITION No -0349 P. 3/4 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA716.4 CRIMINAL MISCHIEF 2ND DEGREE - 1970 COURT CASE ID: 06521 FECR088336 CHARGE CLASS: FELONY CONVICTION TRK#: IA0070MOI RESTITUTION SENTENCE DISP EFF DAT FINE $750 20110628 SUSPENDED FINE $750 20110628 PRISON 5Y 20110628 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA706.2(1) ASSAULT INTENT TO INFLICT SERIOUS INJURY -1978 COURT CASE ID: 06521 PECRO88338w.- CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A007OM02 RESTITUTION SENTENCE DISP EFF DAT FINE $625 20110626 SUSPENDED FINE $625 20110626 PRISON 2Y 20110628 COURT DISPOSITION •De c, 30. 2016 8:57AM Div of Criminal Investigation No. 0349 P. 4/4 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 04 IA STATUTE: IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFF COURT CASE ID: 06521 PECROB0338 CHARGE CLASS! MISDEMEANOR CONVICTION TRK#: 1A0070M04 LICENSE REVOKED RESTITUTION SENTENCE JAIL 6M FINE SIA75 04 RECEIVED 20110628 AGENCY: IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA690.4 CUSTODY IOWA DEPT OF CORRECTIONS TRH#: CB00C4001 INMATE #: 6793503 CUSTODY AGENCY: IA077015G ADULT PAROLE SVC A 20120425 PAROLED CUSTODY AGENCY; IA077015G ADULT PAROLE SVC B 20130407 DISCHARGED PCI 00776527 PAGE 3 OF 3 DISP EFF DAT 20110628 20110628 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