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Home My WebLink About18-001/ IDENTIFICATION NO. L-20 1, t 1 (Office Use Only) oil III CITY OF IOWA CITY APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (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) 3S6-5040 (319) 356-5497 FAX Fi Middle Last ¢¢ 1. Name (REQUIRED) fop ?p -j iQi}yMu✓D /'o ecL41 2. Address (REQUIRED) 0-.,FfeaA 5]2 x l /�,//5 114 o qq�� / 3. Contact Information(REQUIRED) Email FerEr�s�cS medlaccm6)pn6C Cell Phone: Q(�/f '.ZIU" gg (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 4EGG-✓rkt 14 .?D/g b. Taxicab Business Name (REQUIRED) �E��a vu /'fY� OF /OUM 4;ZZ 5. Prior experience in transportation of passengers: wL 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? SGS Type of offense Where When What h4ppened to the charge? (Circle one) Convict Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When kfiAlti F c✓m1N4At ,nlsrJo,�F /cwf G,1`/ S�Pr9 2009 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? Alb Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please providttheWme(s) . DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE -CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF, REW M You must apply for an individual Department of Criminal Investigation Report (form available upon reque. (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) l ( s 0712016 ' , Y j64th'� t �� t d ':` ki n;':: } 4�r,� - h .r � ., . �.. ' y�'' •:. IN It b.• at o a. ' .� r �., Wa I'r6 .< v?a fps x� .b� .jam i v:� > � k L2 t: � � t s1i� +, � •- '.+ Y.� a�,. ,tF" Sc 4 a F�•r _ c.y� tip, ,' ffi , � sir Ie ♦ Srti +,' • ( Y3 LTt j .x ::r F, s .: 4. 1 Ft '�, rig 'M t ' ° ,R:7"' 1 �3`f ";� �•'. va 7F`I F,r.YY,r _ ti . i r�37,4.`y+.'.", b i;.. " 3'7i�krt }+� 1 r'�ti�•, bd \~ '�. �i.Fi�1�9ul .sa, :ae,t Li �J.i�*•t v� ). �, .. �i 4r �i �3r xD {� ��,�. r r♦ .y a M r t < ♦ 1 v �, rrn f r(tT gal It¢� �.� <f'.' OCe .:�� M 4! _3 1. 43.: .✓��• o-i d.,1..: v. e. ^�%F'°,4�(, c4. 1 _ c} � a , 1•:� '..,-t.4� '!x �t .d;\l, � -i 1 Y r } itY z , r 3in'~tirr•3` ''i i3 '�FY t `'� + r �xr :. 'Ya �' .. g a '. r .. � t., i• ' � de y.,. � :.t_ o �'. �.r4 -1 J3^ Z` - ' i �y i T - r 1rt F N Fi •'MIt 4:j'i t{ t [ yF �b 11 4 � : "R F'�r •T t� 1 e' �i �r,'. •. '3 �` -, }. iF� l� ✓T t i �SRsy � ii�i.:�.: � , .t r ...r - xta .. _ . - .• j..,R '.- � .L ik w it +? t ��•'. -, xf ".i Tar i �.i av'•.:: d �"W # a�{1s"' "'YY`1 (!Sl r Y' . >•" 'nib I< � r¢, r * NSM'. Nt c. ��3yr°,�,w � s p 4t� . ♦ •, .. , ,3 x -: �-r [ •.G'�! � a.:S..;a •yr r�t,t•J :�. air '.� �r 2'. r ..{r Ale, litlw a•. APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a v id Driver's license number y'±% ✓✓ Z": 30 issued on /2'.3 • i expiring on /a, Y, � . I understand that if I falsely answer any questions in this application, that this application 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 Applicant %z Date 5 20le Yf11 1f111111fNYf11 fYflYff11N1NN11fi1NYlYltYNiiY�fikilfflfflflNNNtlfl'If1Nf'1N STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by c 6' t CeuuptL_ a _y" � Cti S ° . MAsVJER CoumW on this 5- day of Public in alrd for the State of 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). 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. Signat re of City Clerk oqAesignee / t (i/ A /jV Dat NYNY.....,1f..f..1f..1f f.1f..f..1f.11NNN... ................ Office Use Only N O_ Approved application =� DCI report State certified driving record 7 Ln r Website update17-1 • w DaMRAXIIX2NBADGEAPPL92014em nded DOC 07/201 b' Iowa Department of Transportation 0 Man d D*w Smvien (fdl Flee) NO -632-1121 PO Bax 9304, OBa lilalttes, IA 5U3D&QM 515-2444124 fAfC 515.2341837 Inquiry Date: Name: Address: City/State: Mailing Address: Mailing City/State: Convictions Certified Abstract of Driving Record 1/4/2018 DL/ID Connolly, Robert Class: Raymond JR None 21 Second St Apt 2 Audit a: VAL Issue Date: Hills, IA 52235 Expiration Date: 12/04/2018 Endorsements: PO BOX 7 Restrictions: 429VV6230 (JA) Customer it: 2681075 D ID Status: None 8662133 DL Status: VAL 12/03/2014 CDL Status: None 12/04/2018 CDL Cert Status: None Chauffeur 3 CDL Med Status: None Corrective Lenses Restriction None Operating While Supplement: IA Date of Birth: 12/04/1959 HILLS, IA Sex: M 522350007 History Information Citation Date Conviction Date ACD Explanation County JUR 09/11/2008 02/05/2009 A20 Operating While Johnson IA OWI Test Failure IA Intoxicated Disqualified 10111/2008 09/09/2009 06/28/2011 A20 Operating While Johnson IA Revoked 12/09/2009 12/03/2010 Intoxicated OWI Test Failure IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Ex lanation UR County 09/1 2008 A98 OWI Test Failure IIA Johnson D9/0 2009 A96 IOWl Test Failure IA Johnson - Sanctions Type Effective End ACD Explanation Occurrence JUR ` v JUS 1, Revoked 09/22/2008 03Z20/2009 A98 OWI Test Failure IA IA, . Disqualified 10111/2008 10 10 2009 A98 OWI Test Failure IA IA Revoked 12/09/2009 12/03/2010 A98 OWI Test Failure IA IA Name: Connolly, Robert Raymond )R DL/ID: 429W6230 Pursuant to Iowa Code 4321.10, I, Mellssa 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: 1/4/2018 IOWA . D, 0. T4 Office of Driver Services Iowa Department of Transporation Name: Connolly, Robert Raymond )R DL/ID: 429W6230 N 0 CJ _-n ne L c r -<�- m M '' W Dec.29• 2017 9:02AM Div of Criminal Investigation No.9704 P. 1/4 12.enieuv uu:5i rei row Cob or rur+" �r iy (FAX)310=2-1..�....,/D02 STATE OF IOWA Criminal History Record Check Request Form TO; Iowa Division of Criminal Investigation Support Operallons Bureau, I" Floor 215 B, 7'a Street Dol Molnes, Iowa 50319 (515)725.6066 (515) 72S-6080 Fax I Am renuastina an inwn Criminal Wlatnry It annrA Chenle nn, DCI Account Number: 9967 -It —'- prappne.ble> From, Ye11oW Cab of IOWA City P.O. Hoz 428 Iowa City, IA. 52244 (319) 338.9777 Phone: Fax, (319) 339-7302 Last Name (Mandatory) First Name (mandatary) ]Middle Name r•eommendad Lr' N i vPA c V/ Date -of Birth (minduory) GelfdtlF miedoioiiT ' "" -' —' 'Social -Security Number recommended �eGs 0 9Male ❑Female IJ .,$ — 313 Waiverlpformoflonr Without am igned waiver from the subject of the roll vest, it complete grlminnl history record may not be releosablo, per Code or Iowa, Chapter 692.2. For tomolete criminal history -record Information, as allowed by law, always obtain a waiver signature from the subject of the request. WalVer BillsaSBt 1 hereby sive porm4elon far the above imqueatins *metal to owduot an Iowa criminal hhtoryteoerd aback with the Division of Criminal Inveideodon WCO. My criminal history data eoreemins Me that is m in,dned by,ho DT may ba ralaeud ae showed by law. Waiver Signature, / (DCI on only) As of a search of the provided name and date of birth reveeted: 0 m ❑ No Iowa Criminal History Record found with DCI � �-7 u: n- cri r' 1 i Iowa Criminal history Record attached, nCI # 7 U / ;; i [Tl ACIlnitials DCl-77 (08/25/10) Received Time Dec.28. 2017 948AM No. 2065 Dec.29. 2011 9:02AM Div of Criminal Investigation IOWA CRIMINAL HISTORY FELONY CONVICTION DCI:00776527 NAME: CONNOLLY,ROBERT RAYMOND CONNOLLY,ROBERT RAYMOND JR DOB SEX RAC HGT WGT EYE HAIR 19591204 M W 509 172 BLU BRO ADDITIONAL IDENTIFIERS SC HEAD TAT CHEST TAT UL ARM TAT UR ARM PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRE6TED/TAKEN INTO CUSTODY 20060516 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA708-6 INTIMIDATION W/DANGEROUS WEAPON TRK#: 101868501 COURT DISPOSITION AGENCY. IA0520ISJ 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#: 101868501 SENTENCE DEFERRED JUDGEMENT $750 CIVIL PENALTY PROBATION 2Y SUPERVISED PROBATION TO DCS FINE $750 SUSPENDED PRISON 5Y PRISON 5Y PROBATION UPON 3Y REVOCATION OF DEFERRED JUDGMENT REVOKED IMPOSED 5Y 02 ARRESTED/TAKEN INTO CUSTODY 20080911 AGENCY: IAD520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 18T OFF TRK#: 1A0053N01 COURT DISPOSITION 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 OWCRO84600 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0053NO1 DCI 00776527 PAGE I OF 3 DATE PRINTED - 2017/12/29 SKN P06 Ni DISP EFF DAT 20070914 20070914 20090213 20090213 20090213 20090213 20090213 20110628 No.9104 P, 2/4 N 0 C-) m zf �{ C7 c Dec. 29. 2017 9:02AM Div of Criminal Investigation No. 9704 P. 3/4 DCI 00776527 PAGE 2 OF 3 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION RESTITUTION CRIMINAL MISCHIEF 19T DEGREE - 1970 SENTENCE TRK#: 1A0070M01 DISP EFF DAT SUSPENDED JAIL 173D 20090205 JAIL 180D 20090205 FINE $1250 20090205 PROBATION 2Y 20090205 IMPOSED 1731) 20091201 REVOKED TRK#: 1A0070M04 20091201 03 ARRESTED/TAKEN INTO C08TODY 20090909 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA716.3 CRIMINAL MISCHIEF 19T DEGREE - 1970 TRK#: 1A0070M01 CHARGE NO- 02 IA STATUTE IA708.4(2) WILLFUL INJURY - CAUSING BODILY INJURY TRK#• 1A0070M02 CHARGE NO- 04 IA STATUTE IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFF TRK#: 1A0070M04 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA716.4 CRIMINAL MISCHIEF 2ND DEGREE - 1978 COURT CASE ID: 06521 PECR088338 CHARGE CLASS- FELONY CONVICTION TRK#: lA0070M0I 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: IA708.2(1) C7 < ASSAULT INTENT TO INFLICT SBRIOU9 INJURY -1978 C7 COURT CASE ID: 06521 FECR0O8338 ;<rn CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0070M02 ,:x RESTITUTION ' SENTENCE DISP EFF DAT FINE $625 20110628 SUSPENDED FINE $625 20110628 PRISON 2Y 20110628 COURT DISPOSITION rn 0 Dec.29. 2011 9:02AM Div of Criminal Investigation No. 9104 P. 4/4 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT HO- 04 IA STATUTE- IA321J.2(B) OPER VHH WH INT (OWI) / 2ND OFF COURT CASE ID: 06521 FECRO88338 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A007OM04 LICENSE REVOKED RESTITUTION SENTENCE JAIL 6M FINE $1875 04 RECEIVED 20110628 AGENCY: IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA690.4 CUSTODY IOWA DEPT OF CORRECTIONS TRK#: CBOOC4G01 INMATE #: 6793503 CUSTODY AGENCY: IA077015G ADULT PAROLE SVC A 20120425 PAROLED CUSTODY AGENCY: XA077015G ADULT PAROLE SVC B 20130407 DISCHARGED DCI 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 ,'Y u 7<r N O_ z %1 r m 0 cce---j