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Home My WebLink About12-124CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 3S6-5497 FAX First 1. Name Q bf ENT= 2. Mailing Address el 0 6 2+d -S, 3. Telephone: Home (PI) y35- t 0 Authorization Number/ ? - 127 Z (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) i4YA/E f) LA 14R -T Gr,�1 13iiii 319--i"T6c7 4. Prior experience in transportation of passengers: ,4 i r a ¢ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? y CS y�Where When / C,, • f o7r9U G 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?— IVC 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? A/ILO Type of offense Where When &o6a_ — 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) V c __ 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) clerk/ jdriv adg Ob Moll.. I her byy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number r� 5 C Ci S! (, 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) %//� o Signature of Applicant [yZ,1,4 ice, Dated « l Z »*RRRRRRRRRR..RR1f R1Rff.1R.f111f1ff.«1fY##YfY#####Y#Y*###YY###Y#Y##f#f#*f#1fYY#Y###Y#1f#YY####Yf######.ff.1f*1f.lff.ff#f.f#1111f..f..##.....** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by n w. DV#e,(,1 . On thisy day of I 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). Signature o�olic>�f or designee �7e. SignWure of City Clerk or designee t7-/2 iz Date 71,--2-/.,-2- 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. Y#*#*Y**#**!#**R*#*i**#Rf!******!R!!lfitRRtflfR1f11ffifNfflffl'iflfifffflffl!llffRf*1fflRR1111fRlfifl`fiifRlRf*!!*1RR1flRlflR!#*Rf!!!*1fRN11f1fff Office Use Only Approved application DCI report State certified driving record Website update c.e .dnvbadgeaW IO d. OBf2939 �mhoZ Jun.26. 2012 10:20AM Div of Criminal lnvest;;ation •2012-06-18 07:55 AIRPORT SHUTTLE SERV 3196621094 >> 1 STATE OF IOWA Criminal Hi5tory Record Check Request li o>c•fn To: lowa nir ision of crlwagl investigation support operations Burean, P' Floor 215 n. 7'" Street Des Moli ev, Iowa so 19 (515) 726.6066 (515) 725-6080 Fa: Data `0/° (- /� Gue,ti-i , r\ -- No. 0648 P. 1/2 515 725 6081 P 2/2 DCI Account Number: q- qL — ////�� (Ifappllca((h�+ie) FromS1 t'rrt�l+'� (-e,. ata•111 A��l(, CarlL�s�_5 i Phottei �� Jto� t _ FRE. 39 tarn 1031 Ebelnale rte, Y79- 9G -Gz7? 11'49ver lRforrftdttddtr Without a signed waivprfrom the subject of the request, a complete criminal history record may not be releasable, per code oflowo, Chapter 692.2, ForgogirildetqcrimfiRal history record i6faralatioo, 0 allowed by lsty, always MtAla a walv"elan ehu. Wrliver.IteleaSe; T Irc shy Qlvd pmnisslan tat ate eGhvo tt4Yeaang ficial to eondatt se lotto climinel b'atoryrccord Me& With Ihd Dlisloh ofCrrmintl 1nvNdgtllan lDCq. My crlml"I hlslory dais cooeWlA n,egel la malnlsSacd by We DCl may he relesscd is h116Nxd bylaw, .,f ff`rriverStgircture: Iowa Criminal History Record Check Results ''As of v� 6 �� a search of tho provided name and ditto of birth revealed: r„ ❑ No IOWA Ctintltual FTytary kccord found With )7CI , Towa Criminal history Record attache`d,,ACr# F DCTinitials__-J u PCI -77 (08/35/10) Received Time Jun. 18. 2012 9:25AM No. 8124 Jun.26. 2012 10:21AM Div of Criminal Invest:;ation ADDITIONAL IDENTIFIER$ CCH RECORD *** 01 ARRESTED 19931106 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- O1 IA STATUTE ' IA321J-2 OWI TRK#: 006301201 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA321.277 RRCKLESS DRIVING CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 006301201 SENTENCE DISP EFF DAT PLEAD GUILTY 19931220 PINE $50 19931220 COURT COSTS 19931220 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDFVIFXCATION 13 A PUBLIC RECORD BUT CAN ONLY RE RELEASED TO NON -LAW MENT AGENCIES BY THE DCI. IN ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.0648 P. 2/2 IOWA CRIMINAL HISTORY DCT 00470181 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00470181 2012/06/26 NAME: DUARTE,QUENTIN WAYNE DOB SEX RAC HGT WGT EYE HAIR SEN POE 19641006 M W 507 206 HAZ BRO IA ADDITIONAL IDENTIFIER$ CCH RECORD *** 01 ARRESTED 19931106 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- O1 IA STATUTE ' IA321J-2 OWI TRK#: 006301201 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA321.277 RRCKLESS DRIVING CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 006301201 SENTENCE DISP EFF DAT PLEAD GUILTY 19931220 PINE $50 19931220 COURT COSTS 19931220 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDFVIFXCATION 13 A PUBLIC RECORD BUT CAN ONLY RE RELEASED TO NON -LAW MENT AGENCIES BY THE DCI. IN 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 No.0648 P. 2/2 CIowa Department ofTransportation Office of Driver Services (Toll Free) B00-532-1121 PO Box 9204, Des Willies, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 7/11/2012 DL/ID #: 083CC4628 (IA) Customer #: 2146134 Name: Duarte, Quentin Wayne Class: D ID Status: None Address: 406 2ND ST S Audit #: 5636630 DL Status: VAL Issue Date: 11/17/2011 CDL Status: None City/State: COGGON, IA Expiration 10/06/2012 CDL Cert None 522189417 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 406 2ND ST S Restrictions: None Restriction Medical report required Date of Birth: 10/6/1964 Supplement: July, 2011 Mailing City/State: COGGON, IA Sex: M 522189417 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 03/19/2009 _ 498858 IA Name: Duarte, Quentin Wayne DL/ID: 083CC4628 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: +"""• :,f*; 4i 7/11/2012 IOWA :?, ......S`cQ- ER Office of Driver Services a1111NIA� Iowa Department of Transportation Name: Duarte, Quentin Wayne DL/ID: 083CC4628