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Home My WebLink About17-072CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO 1 -7 -a -7D. (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 1. Name (REQUIRED) 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pE sent Phone: ` ) - T� 22 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?�C� Type of offense Where When % a �Z to c1!3 � 1�)re , woo l 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? 11 E� Type of offense Where When o What happened to the charge? (Circle one) un 1 Convicted Dismissed Deferred Suspended Plead Guil J tht 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense n Where When 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-certifythat I have issyed to me by the Iowa a rtment of Transportation a valid Driver's license number ziy Y4s�S J issued on expiring on I understand that if I falsely answer anV q estions in this application, that this ap lica ion 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 a lication, and I fu gree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the isiorsof Title 5, C ter 2, of the City Code. (Needs to be signed in front of a Notary Public) mewl -M-41 _�� MINOR a- • STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribedd sworn anto before me b �,�,� jA , 7D1� y �� i }i(�ftf�acoAtthis ! `J day of 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 Cit"lowa CityLTitle 5, Chapter 2, City Code). 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. StgAaturb of City CI rk or designee Office Use Only Approved application DCI report State certified driving record Website update CIeN fAXIDRIVRADGEAPPL92014 .ded.DOC 07/2016 —+c a cn f�-t7m _J CIeN fAXIDRIVRADGEAPPL92014 .ded.DOC 07/2016 Ma y. 10. 2017 2: 56 PM Div of Criminal Investigation 05/05/201/ 1Z:331'ei iov Cob 07 lova ui cy STATE OF IOWA Criminal History Record Check is Request Form To: Iowa Division of criminal Investigation Support Operations Bureau, I" Floor 316 R. 714 Street Dee Maines, Iowa $0319 (SIS) 735+6066 I am retannatinu an Tnwa f!rl mtnwl Ulammi vrn..e.d nt—t- No -9046 P. 1 (FAX)319338VV9 02/003 C AGI AocountNumber: —9967^)F (I[oppllcatle) Froml Yellow Cab of Iowa City P.O. Box 428 Iowa City, IA. 52244 (319) 338.9777 Pdonet Fax: (319) 339-1302 L st Name (meaEsio First Name (monamo Muddle Name recommended) Date of Birth (mendste Gender (mendm Social eaurl Number recommendde U 1�C o ❑Male ample �'� �� Waiver Iriformailonr Without a.signed waiver from tha subject of the request, a complete oriminalhlstory record 'may not be releasable, per Code of Iowa, Chapter 693.3. For c et criminal history record lorormation, as alleveed bylaw, always o toln a waiver signature from the sub ect of there hest. WalvarRelease;iherebyglvepermaetoa(arihe vercqueedngCal llelrocea owes nalhlnory record dhlCkwlth(ho Division [CHmlml Invelllpmion(DC). Anyeriminelhhtorydemc ne lhethmelnlelaedby Cl maylrorale edeullowed bylaw, Waiver ,S1gnai et . (DCI use only) As of a search of the provided name and date of birth revealed: ❑ No Iowa, Criminal History Record found with DCT Iowa Criminal history Record attached, I)CI # / �al- DCI initials___vv — t� DCI -77 (08/15110) Rtreiveri Time May. 5. 9017 19:44PM No. 8674 May.10. 2011 2:56PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCT 00652882 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - 2017/05/10 DCIc00652882 NAME: ACHENBACH,CASSANDRA ANN DOB SEK RAC HOT WGT EYE HAIR SKN POB 19810814 F W 503 125 BRO BLN IA ADDITIONAL IDENTIFIERS SC ABDOM SC BREAST SC NECK TAT BACK TAT CHEST TAT FNGR TAT L ARM TAT UL ARM CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20010911 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO— 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRK#: 100337601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTE: IA321J.2(8) OPER VEH WH TNT (OWI) / AGR MISD / 2ND OFF - COURT CASE ID: 06521 OWCRO59873 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100337601 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 7D 20011128 FINE $1500 20011128 02 ARRESTED/TAKEN INTO CUSTODY 20020326 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- 01 IA STATUTE IA321—S61 DRIVING W/LIC BARRED TRK#: 052364401 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER — 1978 COURT CASE ID: 07161 AOCRO17033 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 052384401 SENTENCE DISP EFF DAT SUSPENDED JAIL 150D 20020816 JAIL 1801) 20020816 FINE $500 20020816 No.9046 P. 2 May.10. 2011 2:56PM Div of Criminal Investigation PROBATION 365D 03 ARRESTED/TAKEN INTO CUSTODY 20020603 AGENCY: IA0820200 DAVENPORT PD CHARGE NO- 01 IA STATUTE IA321-561 DRIVE BARRED TRK#: 901994101 COURT DISPOSITION AGENCY: IA082015J COUNT NO- 01 SCOTT CO DIST COURT IA STATUTE; IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 07821 AGCR250840 CHARGE CLASS: MISDEMEANOR CONVICTION TRK$: 901994101 SENTENCE SUSPENDED JAIL 240D JAIL 240D FINE $650 PROBATION IY 04 ARRESTRD/TAKEN INTO CUSTODY 20080615 AGENCY: IA0160100 TIPTON PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER 1978 TRK#: 081258401 COURT DISPOSITION AGENCY: IA016015J COUNT NO- 01 CEDAR CO DIST COURT IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 07161 AGCR020465 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 081258401 SENTENCE SUSPENDED JAIL 120D JAIL 180D SUSPENDED FINE $625 FINE $625 UNSUPERVISED 365D PROBATION 05 ARRESTED/TAKEN INTO CUSTODY 20130329 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- 01 IA STATUTE IA717B.3(3) ANIMAL NEGLECT - DEATH OR INJURY TRK#: 090853801 COURT DISPOSITION AGENCY: IA0160159 CEDAR CO DIST COURT DCI 00652882 PAGE 2 OF 3 20020816 DISP EFF DAT 20020805 20020805 20020805 20020805 DISP EFF DAT 20080801 20080801 20080801 20080801 20080801 No.9046 P. 3 May.10. 2017 2:57PM Div of Criminal Investigation No.9046 P. 4 COUNT NO- 01 IA STATUTE; IA717B.3(3) (S) ANIMAL NEOLECT - DEATH OR INJURY COURT CASE ID; 07161 SRCR022500 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 090853801 RESTITUTION SENTENCE SUSPENDED JAIL 30D JAIL 30D FINE $315 UNSUPERVISED lY PROBATION DCS 00652882 PAGE 3 OF 3 DISP EFF DAT 20130329 20130329 20130329 20130329 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF QUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAN 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 CIowa Department of Transportation Office of Omref services (roll Free)x-532-1121 PO Box 92114, Des Manes, ]A 50306 9204 515244-9124 FAx 515239.1837 Certified Abstract of Driving Record Inquiry Date: 5/4/2017 DL/ID #: 542YY8155(IA) Customer #: 4901079 Name: Achenbach, Class: C ID Status: EXP JUR Cassandra Ann Suspended Suspended, Denied, 11/18/2015 D53 Address: 414 WATERWAY DR Audit #: 1790511 DL Status: VAL 08/18/2013 04/15/2014 Issue Date: 05/04/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 08/14/2024 CDL Cert Status: None 05124/2015 522466108 S92 Speed Washln ton IA 08/17/2016 09/20/2016 Endorsements: NONE CDL Med Status: None Mailing Address: 414 WATERWAY DR Restrictions: NONE Restriction None Registration Supplement: Date of Birth: 8/14/1981 Mallin IOWA CITY, IA Sex: F City/state: 522466108 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/18/2013 04/15/2014 B20 Driving While Iowa IA JUR Suspended Suspended, Denied, 11/18/2015 D53 Non -Payment of IA IA Cancelled Revoked 08/18/2013 04/15/2014 072 Fail to Have Vehicle Iowa IA 04/19/2017 D53 Non -Payment of Under Control IA 05124/2015 07/07/2015 S92 Speed Washln ton IA 08/17/2016 09/20/2016 B64 No Insurance Card Johnson IA 08/17/2016 09/20/2016 Improper Johnson IA Registration Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 10/12/2015 11/18/2015 D53 Non -Payment of IA IA Iowa Fine Suspended 12/26/2016 04/19/2017 D53 Non -Payment of IA IA Iowa Fine Suspended 12/27/2016 04/19/2017 D53 Non -Payment of IA IA Iowa Fine Name: Achenbach, Cassandra Ann DL/ID: 542YY8155 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. 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: i` Z4 5/4/2017 I OWA d. 0. T. Office of Driver Services Iowa Department of Transporation Name: Achenbach, Cassandra Ann DL/ID: 542YY8155 i