HomeMy WebLinkAbout17-083nd
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
IDENTIFICATION NO. ) !]— 3_
(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
2. Address (REQUIRED) 4W41' TPT 4✓e d/2C --e� 4a S?ZSY0
3. Contact Information (REQUIRED) Email: A noC� M S.v,Ceivi Cell Phone: =30S 3 1 d' 4-.6R3
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) Y— 1 S — 2 D 1 `]
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of passengers:
(�e� Lir.1E V�-I� �absa (C. 5 :�zn2s inxr Cac�
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
z>•ss or.
What happened to the charge? (Circle one) r-) r r.
Convicted Dismissed Deferred Suspended QPlead GuillyherrrI MW���
Have you been arrested/ charged with any traffic offenses in the last five years?
Type of offense Where :,Wheno
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s; e- 4 �0L-0f-r'ef✓ n2— ZZ - 2o15.
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended I6lead Guilty Ofher
m
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /J
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 name(s) A.; Z7
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
,.r
% ,APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
C, 3 8 C� 11 '75 ci .3 issued on r,i -CV 1 -1 expiring on Gs -- 1 5 -1 7 . I understand that if I
falsely answer any questions in this application, that this application may be denied. 1 agree that in making this application, I
consent to allow agents or employees of the City of tow@ City, Iowa, in their discretion, to examine any and all records and
documents relating to this application, and I further agreitffiat,y authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions of Title. l , hapter 2, of the City,Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant 4 Date-<P`e 1, 1-0/7
STATE OF IOWA )
COUNTY OF JOHNSON )
and sworn to before me by �1
f✓GS VCt��t?� on this 'St
in and for the Stale Of Iowa
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 City of Iowa City (Title 5, Chapter 2, City Code).
of
license t /I r'
or designee
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.
SignatUrp of City -Clerk or designee
�,,\-,\ �-2
Date
Office Use Only
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.
SignatUrp of City -Clerk or designee
�,,\-,\ �-2
Date
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Office Use Only
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Approved application
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DCI report
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State certified driving record
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SMARTER (SIMPLER I CUSTOMER. DRIVEN
www,lowadotgov
Inquiry
Date:
Customer
Name:
Address:
City/State:
Mailing
Address:
Mailing
City/State:
Date of
Birth:
Sex:
Convictions
6/1/2017
6027518
Page 1 of 2
Office of Driver Services
PO Box 9204 1 Des Moines, IA. 50306-9204
Phone: 515-244-91241800-532-11211. Fax: 515-239-1837
www.iowadat.gov
Certified Abstract of Driving Record
DL/ID #: 638AH7593 (IA) CDL Permit Class: None
Class: D
Rivas Valle, Jorge Aldo Audit #: 1602090
4494 TAFT AVE SE LOT Issue Date: 02/09/2017
19C
8/15/1952
YL
History Information
CDL Permit Issue None
Date:
CDL Permit
Expiration
08/15/2017
None
Date:
None
IOWA CITY, IA
Endorsements: 3
522408166
None
Restrictions:
4494 TAFf AVE SE LOT
Restrictions:
Corrective Lenses
19C
Restriction
None
IOWA CITY, IA
Supplement:
522408166
8/15/1952
YL
History Information
CDL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
None
CDL Permit
None
Endorsements:
04/03/2013
CDL Permit
None
Restrictions:
IA
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Permit
ELG
Status:
04/03/2013
CDL Cert Status:
None
CDL Med Status: None
Citation Date
Conviction Date
ACD
Explanation
County
JUR
01/03/2013
04/03/2013
M14
Fail to Obey Traffic Sign/SignalJohnson
IA
02/22/2014
04/29/2014
S92
Speed
Johnson
IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
05/03/2017 1983067 IIA
Name: Rivas Valle, Jorge Aldo DL/ID: 638AH7593
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:
6/1/2017
o's/Ma y. 30; 20112 2:17PM�db Div of Criminal Investigation (Fkx)',,79°.3e2iNo. 1565 P. 3/5/On5
... �,
y,STATE OF IOWA . Criminal History Record Check
.:
f/y N
Request Form
o V
VIn.�'T
'arnoH1°�
DCI Account Numbor; _9967-F
(Ir app] IcAble)
To: town Division ol-Crinilnnl Investigation rrotn: Yellow Cab orIowa City
Support Operations Bureau, I" floor P.O. Box 428
215 Z. 7" street
Des Moines, Iowa 503I9 Iowo City, U. 52244
(315) 7256066
iStS�P-2.5-60 -
phone;
rax: (319)339-7302
Iowa Criminal History .Record Check Results.
As of 6,-Iyi'-0 , a search of the provided name and dare of birth revealed;
�No Iowa Criminal History Record found with DCI
0 Iowa Criminal History Reool'd attached, ACI
DCI Initials
OCI.77 (08/25/10)
Receiveo Time May. 18, 2017 9:36AM No. 9567
(PC[ u(o only)
Page 2 of 2
6/1/201 i^ Qp
Office of Driver Services
Iowa Department of Transportation
Name: Rivas Valle,Jorge Aldo DL/ID: 638AH7593
6/1/2017