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Home My WebLink About18-006 + IDENTIFICATION NO. / 4 r 1 ((Ince Use Only) :rule 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) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) L ( C t 1 A C' DUI\ fZ 2. Address(REQUIRED) 12(7 G 0A ST . T �� 4 C S 22 L( o 3. Contact Information(REQUIRED) Email: )23& R yOlioc,. Cc'.'! Cell Phone: -SI Y- f{ }J- } ( 1 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 12 12 W 12. YZ 3 b. Taxicab Business Name (REQUIRED) \pN I t u.J C Q(. 5. Prior experience in transportation of passengers: v' 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 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? Type of offense Where When What happened to the charge? (Circle one) 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? )'i u Type of offense Where When ry7 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the narnre(s) 2 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERii1E137 rn DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW s, 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 have issued to me by the Iowa Department of Transportation a valid Driver's license number S.S X i UR Sy issued on el I cbf 16 expiring on 12,.2111 2 OZ 3 . 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 Date 01 1 1 3-) I k STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by LL,,' S A . CItaNi Ecltokaccr on this /-7 day of Zc .?1 ` . � 411. is t wENDY S.MAYER l� u A�o62 w Commission Number 729128 Notary PPblic in ap�for the State of Iowa ►� a ,DtFrrea '1/41 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 1 C.A4((2_,0Z3 a51)-- , /,77-7_0-, -6 Signature of Police Chief 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. I c. L,-e fili L `— ) / / J /1 Signature of City Cle or designee Dat N C::) CD :gin �;. wn Office Use Only y--1 = c�-< —-_.r i- --lc) Approved application `{rn DCI report4.,j State certified driving records.; Website update c, Clerk/TAXIDRNBADGEAPPL92014amended.DOC 07/2016 IOWA DOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 1 800-532-1121 I Fax:515-239-1837 www.iowadotgov Certified Abstract of Driving Record Inquiry 1/17/2018 DL/ID #: 555XX6834 (IA) CDL Permit Class: None Date: Customer 406903 Class: A CDL Permit Issue None #: Date: Name: Chay Escobar, Luis Audit #: 9688823 CDL Permit None Alfonso Expiration Date: Address: 1206 DIANA ST Issue Date: 01/06/2016 CDL Permit None Endorsements: Expiration 12/24/2023 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: Passenger ID Status: None 522404629 Mailing 1206 DIANA ST Restrictions: CDL Intrastate Only, No DL Status: VAL Address: Class A Passenger Vehicle Restriction None CDL Status: VAL Mailing IOWA CITY, IA Supplement: • CDL Permit ELG City/State: 522404629 Status: Date of 12/24/1963 CDL Cert Status: Non-Excepted Intrastate Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Chay Escobar, Luis Alfonso DL/ID: 555XX6834 (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: cra r � .......••12I, 1/17/2018 y-1 IOWA ':s%� c -� �'" .C : : tri U -1C< D. 0. T. f �C«.tl -�r" -�, rn rn 4111 UT DRIVER$�`I Office of Driver Services C C.11��``..� Iowa Department of Transportation •• N r.„) http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 1/17/2018 .ate- .»b..... ..� .. Ntme:Chay Escobar, Luls Alfonso DL/ID: 555XX6834 (IA) C1 maC") '"..f rn N C.) http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 1/17/2018 o.t,Jan. 10• 201132 ii:7URmCab utv 01 Vt Iiii IIIa• in.�.. L , e,.. • . STATE OF IOWA r j;�� ., •, Criminal History Record Check . :k-, ` ;' : . ,.."� ,. ;� Request Form tl'.. �i+'..,. ,iii Dm Account Number; 9967-F or oppbabte) To: Iowa Divieton of Criminal Investigation From: Yellow Cab of Tows city Support Operations Bureau, 1"Floor P,O,Box 428 215 E. 7,"Street Des Moines,.lows 503]9 Iowa City, IA, 52244 (515)725-6066 (319)3389777 (515)725.6080 Fax Phenol Fax: (319) 339-7302 1am requesting an Iowa Criminal History Record Cheek on: r Last Name (mandatory) _ First Name (mandatory) Middle Name(recommended) CWttkl. EaCdt A a 1()1 Mf;' )S a — Dnte 0f Birth (mandatory) _ Gondol!(mndetory) 'Social•Security Number(recommended) 1 j19la. .. MA-ale OFemale • S25— S ^3-31 n Waiver Information: Without a signed walvor from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2.For srgr pJ tg criminal hlstory,record information,as allowed by taw,always obtain a waiver sl;nature from the sub act of the re.uest. . Waiver Release;1 hcroby give permission ibr the above requesting allele}to conduct en lows criminal history record check with the Division of Criminal investigation(Del), My criminal history data oonceming me that is maintained by the DCI may be released as allowed by law. Waiver Signature: N1114_ a Iowa Crimji i1 History Record Check Results • e,(1),Clue only) ('� a search of the provided name and date ofbirth retie'As of �� Q : , L 1. — 10 Iowa Criminal T lstary Record found with DCI -•1! U Mt vt - .. Iowa Criminal History Record attached, DCI DCI initials =_ . co DCI.77 (08/25110) T" Received Time Jan. 8. 2018 3: 32PM No, 2524