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Home My WebLink About12-123CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX 1. Name 2. Mailing Authorization Number /0Z. — /tela (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 3. Telephone: Home`31q_�;64I— T3__�9 Other: 4. Prior experience in transportation of passengers: X�b 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? M-0 Type of offense Where When 6. Have you een convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? iJa Tvoe 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) 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) derM"drivbadg ( � G�I�UIZ I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number '77 2, . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 Applicant4 Qt Date 2 Z STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 5r : e\\ �� .1�0 �9 On this 1� day of 1 have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Si4&�� §fiature 6f Police Chief or designee SignAture of City Clerk or designee Date Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. 444444M444444144114444Y411f411f1141fIfH11f11fif11flff41H11114114114111f11ff111114111141f11144111f444#411444444444444444444444444444444fe14414Y Office Use Only Approved application DCI report State certified driving record Website update cled idmbadg app2010 do oCDia01Z Iowa Department of Transportation C3�7 Office of Driver Services (To11 Free) BM -532-1121 PO Box 9204, Des Moines, IA 5030&9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 7/12/2012 Name: Bogs, Danielle Lee Address: 2128 S Riverside Or #40 City/State: Iowa City, IA 52246 Mailing Address: 2128 S Riverside Or #40 Mailing City/State: Iowa City, IA 52246 Convictions Certified Abstract of Driving Record DL/ID #: 773NN3111 (IA) Class: B Audit #: 3009403 Issue Date: 02/11/2009 Expiration Date: 02/04/2014 Endorsements: PS Restrictions: NONE Date of Birth: 2/4/1974 Sex: F History Information Customer #: 3138468 ID Status: None OL Status: VAL CDL Status: VAL CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County JUR 12/04/2010 01/31/2011 D72 Fail to Have Vehicle Under Control 92 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 12/04/2010 607740 IA Name: Bogs, Danielle Lee DL/ID: 773NN3111 Pursuant to Iowa Code §321.10, I, Kim Snook, 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: Name: Bogs, Danielle Lee DL/ID: 773NN3111 7/12/2012 {D Office of Driver Services Iowa Department of Transportation Jul 000I -H. 2012 4:13PM0ab,Div of Criminal Investigation Sts-s3D-2708Na.3134 P. 4 s/ OF • p �HYL1`'Criminal History 1 1 Cheeff Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, V Floor 216 E. 7" Street Des Maines, Iowa SD319 (535) 125-6066 (515)715-6080 Fax 1 am reauesline an Imva Criminal Victnry Raenrd rhaAr , .,, DCI Account Number: 9967-F . (if applicable) From: _ Yellow Cab of Iowa CI!X P,O, Box 428 Iowa City, IA. 62244 (319)338.9777 Phone: Fax: (319) 339-7302 Last Name mandatoo First Name (mandaft)M Middle Name (mcommrnded) 9 i Date of Birth (mahaao y) Gender (mndno ) Social -Security Number (recommended) 2 OMaie MIlernalle �_ g Warverlajormaeiori: Without it signed waiver from the subJectof the request, a complete criminal history record may not be releasable, per Code of Iowa, Chop ler 692.2. For comuletn criminal bistory record Information, as allowed bylaw, always obtain it waiver sigmature from the subject of the request. Waiver Artease: i hereby give pmnissiion forme above rcqucsting o(llcial to conduct an low criminal binory:eeord chak with the Division orCriminal Inrcnigatim (PCT). Any uiminal history data conceming me that is maintained by the DCl maybe reloned as showed bylaw. Waiver Signalurel�ct 0 A Q Iowa Criminal History Record Check Results (oetu eenry) As of�' (��, it search of the provided name and date of birth revealed; I - ❑ No lows Criminal History Record found with DCT �. fowa Criminal History Record attached, DCI it y �% DCl initials_4—A DCI -77 (08125110) Received Time Jul. 9. 2012 2:17PM No, 9183 Jul. 11. 2012 4:14PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00459060 MISDENEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2012/07/11 DCI:00459068 NAME: COBLENTZ,DAHIELLE LRA COBLENTZ,DANIELLH LEE DOB SEX RAC HGT WGT EYE HAIR SKN PDH 19740204 P W 505 150 RAZ SRO FAR IA ADDITIONAL IDENTIFIERS TAT R ARM CCH RECORD *** 01 ARRESTED 19930501 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA714-1 THEFT 47H DEGREE TAX#: 009601601 COURT DISPOSITION AGENCY: IAOS2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2(4) THEFT 4TH DEGREE - 1978 TRK#: 009601601 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19930817 02 ARRESTED 19960105 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401(3) POSSESS'SCHEDULE I/ MARIJUANA TRK#: 013266601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE rA124-401-3 POSSES SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 013266601 SENTENCE DI6P EFF DAT FINE $250 19960208 AN ARREST WITHOUT DISPOSITION 18 NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL 1MVE8TIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE: RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. 1V,VjE. ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BA D ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COV THS SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL TNVE8TIGATION No. 3134 P. i