Loading...
HomeMy WebLinkAbout17-110 IDENTIFICATION NO. I ,/-1 I - 1 (Office Use On y) .1111217" ,1 - APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday) 410 East Washington Street Iowa city, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name(REQUIRED) 1t--‘dvec,_ L CSL( 4e,, 2. Address (REQUIRED) (3O 7 air n,5 4-Ve 3. Contact Information (REQUIRED) Email: Cell Phone: 31? 1/3/ yy/� (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) $/L 7/ /3 b. Taxicab Business Name (REQUIRED) e I6it,J (ct=) d J 0 C t 5. Prior experience in transportation of passengers: • 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewre? Type of offense Where itin .. Fere) What happened to the charge?(Circle one) 677 Convicted Dismissed Deferr-• Suspended Plead Guilty Other W 7. Have you been arrested/charged with any traffic offenses in the last five years? r' Type of offense Where When S�ee.cQr►.5c Corc'itir 2610 What happened to the charge?(Circle one) onvicte. 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? 4) 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 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 her bx certify that I have issued to me by the Iowa D pa ment of Transportatio a v i Driver's license number 7 S(Ab`c (Lj issued on g 22 (7 expiring on 101 . I understand that if I falsely answer any questions in this application, that this ap icat n may be denied. I a ree t at 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 provis'ons of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date T"2_ 1//7 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by .-vA.c.a r'2,:. L. . LAS, lc 5 on this ZZ day of A. commission ry .KENDys•MAYER Notary Public iffarcl for the S /e 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 ur,l Signature of Polic Chie 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. Si.'.0 g/ a/i ature of City CI- '1 or designee Dat Office Use Only inan Nhl 1.10. Approved application 7.<141.1 "V ill DCI report . _ 0 State certified driving record tff. w Website update ClerkfTAXIDRIVBADGEAPPL92014amended.DOC 07/2016 GIOWA DOT SMARTER 1 SIMPLER I CUSTOMER DRIVEN wWw.iowadot gov Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 I 800-532-1121 I Fax:515-239-1837 www.iowadot_gov Certified Abstract of Driving Record Inquiry Date: 8/16/2017 DL/ID #: 181AD9000 (IA) CDL Permit Class: None Customer#: 4685633 Class: B CDL Permit Issue None Date: Name: Willis, Andrea Lolita Audit#: 1541035 CDL Permit None Expiration Date: Address: 1307 BURNS AVE Issue Date: 01/10/2017 CDL Permit None Endorsements: Expiration Date: 08/29/2018 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522405868 Endorsements: Passenger, School Bus ID Status: None Mailing 1307 BURNS AVE Restrictions: No Class A Passenger Vehicle DL Status: VAL Address: Restriction None CDL Status: VAL Mailing IOWA CITY, IA 522405868 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 8/29/1980 CDL Cert Status: Excepted Interstate Sex: F CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation JUR County 11/24/2014 01/04/2015 S93 Speed IA Johnson 02/06/2015 06/04/2015 M14 Fail to Obey Traffic Sign/Signal IA Johnson Name: Willis, Andrea Lolita DL/ID: 181AD9000 (IA) 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: gg s...* CIf.. 1, 8/16/2017 •`may GG111 '7 dri llr ..%''' :�� IOWA '•i®:', _-[ ens �"- p7,6466.41) rn §� •. �'.' ces I't`I 'b Me 0 yi411� OBII�R$ � IowaOffiDepartment of Driver eof(Transportation *-:Ilt cop ;,> 0 UR Name: Willis, Andrea Lolita DL/ID: 181AD9000 (IA) Au,g, 21. 2017 8: 14AM Div of Criminal Investigation No. 8644 P. 1 08/16/2017 13:18 Ye I low Cab of Iowa City (FAX)3193382703 P.002/002 • A1Ai!rul4 zoo,fl,.! A �\ ,,..•:'_i• j •4. 0:' 7`h� " ,r `'• i'�4$ ' Criminal History Record heck YYYIII lI ,• r is 1 /i1 A Request Form veFn :,„r:: ,:$ i:;,if DCI Account Number; 9967.F or opplioeblo) To: Iowa Division of Criminal Investigation From: Yellow Cab of Iowa, Iry Support Operations Bureau, l" Floor P.O. Box 428 215 E.7'"Street Des Moines, Iowa 50319 Iowa City, X.A. 52244 (516)725-6066 - (S15)'7-2So6*5—Fa-; 7319)3311-9777 • Phone:' Fax: (319)339-7302 I am requesting an Iowa Criminal History Record Chock on: Last Name(mandatory) Firat Name (mandatory)' Middle Narme(recommended) ' ti Lig( [i"Se.. . LoLI Date of Birth l+nanduory) __ Gendersmandatory) 'Sacial•SecuriNumber (recommended) K/26// D ©MateFemale ` `-7' & 9 —16-1/ Waiver Information; Without 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 aomplete criminal history•rocord information,as allowed by law,always obtain a waiver signature from the subject of the request, , Walver Raga e.I hereby give permission for the above requesting official to conduct in Iowa criminal history record cheek with the Division ofCriminal Investigation(DCI), My criminal history data con Ing me that Is maintained by t o D y he released as allowed by law. __ Waiver Signature; I 1L. _ Iowa Criminal History Record Check Results na (DCI only) AS of ' 2 ' - 1 , a seeroh of the provided name and date of birth reveale c ITI >-4 GI amigo CI•••< TV m. zit r...) 1 a No Iowa Criminal History Record found with DCI L Iowa Criminal History Record attached, DCI# O 1 '� > 0 Lys DCI initials ljt\c\ ICI-71 (08125/10) • n 7 h 1i '1/111 i . nnoI M. /no/ Aug. 21, 2017 8: 14AM Div of Criminal Investigation No. 8644 P. 2 IOWA CRIMINAL HISTORY DCI 01013136 NON CONVICTION PAGE 1 OF 2 DATE PRINTED- 2017/08/21 DCI:01013136 NAME: WILLIS,ANDREA LOLITA DOB SEX RAC HGT WGT EYE HAIR SOT POE 19000829 F B 502 160 SRO SLK LER IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT CHEST TAT R ARM TAT R THGH CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20141003 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA715A.8(3) -A IDENTITY THEFT TRK#: 1A00.JXL01 COURT DISPOSITION AGENCY: 1A052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA715A.8(3) IDENTITY THEFT UNDER $1,000 -- Forgery COURT CASE ID: 06521 FECR106625 CHARGE CLASS: NON CONVICTION TRK#: 1AOOJXL01 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT VICTIM RESTITUTION PAID 20151005 PROBATION 1Y 20151005 DISCHARGED FROM 20160817 DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20150810 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA715A.5 TAMPERING WITH RECORDS - 1987 TRK#: 5A00R3N01 COURT DISPOSITION �► AGENCY: IA057015J LINN CO DIST COURT ;tom, ...� COUNT NO- 01 IA STATUTE: IA71SA,S ,, GGA TAMPERING WITH RECORDS C'j-‹ .3 COURT CASE ID: 06571 AGCR113832 -74C") CHARGE CLASS: NON CONVICTION 7( TRK#: 5A00R3N01 �.J SENTENCE DIED' EFF DAT DEFERRED JUDGEMENT 1Y 20160225 t.Xa PROBATION 1Y 20160225 DISCHARGED FROM EXPUNGED 02/21/2017 20170221 DEFERRED JUDGEMENT Aug. 21. 2017 8: 15AM Div of Criminal Investigation No. 8644 P. 3 DCI 01013136 PAGE 2 OF 2 • AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OP 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 Arabs C7—‹ 1