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Home My WebLink About13-117 Authorization Number I — 1 (Office Use Only) SIIIEEG grit ► : amosailir APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday—Friday.) Iowa City, Iowa 52210-1826 (319) 356-5040 (319) 356-5497 FAX Fir3t Middle L t 1. Name (,( 2. Mailing Address p0. eilk -7/ (J eCu,l ( -Zdc "3� 3. Telephone: Home t1- Other: 4. Prior experience in transportation of passengers:, . 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When (1 t C.lro(s, z-f m 3 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? t\ ) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? A ' J Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4_73 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) /L.'") 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) derkrtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number -77-5 - ;2":: '.S / . I understand that if 1 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) c Signature of Applicant ( Date b,7, STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by W \\ C,r�, ON-}e a , . On this 3r`>\ day of c. a° l3 . NotayPu . in and for the State of Iowa )(3ll4 **..**..*......*.............................****.....*...**.*...****......***..,...***.**..*...****.*****.*.***.,..****..............********** 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). Iii •Sig -t re of ' e Chief or designee cDate YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. ' e..4.- a-i...,: k . 4z. Signat e of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width) and 51/2" (height) and prominently displayed to all passengers. .*......*......*....................*..*...*.....*...****.**.****..*..**.**.***,,,,. **,.,, ,,,i ..................**........................*.. Office Use Only Approved application DCI report State certified driving record Website update derkrtaxidrivbadgeapp2010.doc 03/2013 1 fl Iowa Department of Transportation rnrce sernces (Toll Free)800-532-1121 PO Boxcf 9D204,Des Des Manes,IA 50306-9204 515-244-9124 FAX 515-239.1837 Certified Abstract of Driving Record Inquiry Date: 4/22/2013 DL/ID#: 775ZZ9301 (IA) Customer#: 3632398 Name: Ortega,Will Cruz Class: D ID Status: None Address: 204 4th Street Audit#: 6383498 DL Status: VAL Issue Date: 10/13/2012 CDL Status: None City/State: Conesville,IA Expiration Date: 04/29/2013 CDL Cert Status: None 52739 Endorsements: 3 CDL Med Status: None Mailing Address:, PO BOX 71 Restrictions: NONE Restriction None i Supplement: ', Date of Birth: 4/29/1978 Mailing CONESVILLE,IA Sex: M City/State: 527390071 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 01/05/2003 04/22/2003 A20 Deferred Judgment 70 IA owl Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation JUR 01/05/2003 A90 OWI Test Failure IA Sanctions Type Effective End ACD Explanation Occurrence JUR IUR Revoked 02/12/2003 08/11/2003 A90 OWI Test Failure IA IA Name:Ortega,Will Cruz DL/ID:775ZZ9301 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. 1 a . . IOWA CRIMINAL HISTORY DCI 00689087 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2013/04/24 DCI:00689087 NAME: CRUZ,WILFREDO ORTEGA ORTEGA,WILFREDO CRUS ORTEGA,WILLIE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19780429 M W 509 177 BRO BLK ADDITIONAL IDENTIFIERS SC L HND CCH RECORD *** 01 ARRESTED 20030105 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA321J-2-2A OWI TRK#: M00087001 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 1ST OFF COURT CASE ID: 07701 OWCR025872 CHARGE CLASS: NON CONVICTION TRK#: M00087001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20030422 PROBATION 18M 20030422 COMMUNITY SERVICE 40H 20030422 DISCHARGED FROM 20041027 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENT F CATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW L.. ENFO MENT AGENCIES BY THE DCI. IN TH 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 ,4pe1t1>1PPA or• PUB\ State of Iowa ,(..�; or, c. Q� `" :`,/ Division of Criminal Investigation l y`r. �"y et cr,„ 215E 7th St ° ' A, ' ?c. s IOWA 7.1` Des Moines IA 50319 `vio" """' g 1 > .;m a^ u / d Ph.515-725-6066 Fax 515-725-6080 L i o, .'. v"a \�0 Iowa Criminal History Record Check ,' `$0417.-^gid!"� Walk-In Request I Your name WI,I. ('rtJz (fl7-t-z�t Address , q L4-t& 5c City/State/Zip Cr_,angi,At( t enc_co Fill in all shaded areas. Phone# jS- ?Zs— 6`3 3n Requesting an Iowa criminal history record check on: Last Name Ape/lido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) lf2rcC4A 1.\I I t .O C g-( )z— Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended) Male OFemale 6te/ 172, ySa (e( - 45 Waiver Signatur Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) e Results 0C U5C ONLY As of 1--kb-1/4"a1) , a name and date of birth check revealed: ❑No record found 4J'Record attached, DCI# tc>C\ 0151 DCI initials PR: Receipt Number of requests x $15.00 per last name=Total amount$ Method of payment: El cash ❑money order Ocheck# ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number# Exp. Date •• `I COMPANY ADDENDUM—OWNER INFORMATION (ONE FOR EACH PERSON LISTED IN ITEM 4 OF COMPANY APPLICATION) Owner Name ti i C ckc11 Owner Address aO L4-ds-N (-J City/State/Zip CoVLr.s-utlit .-V.A -Z) _ Contact Phone Number(other than business number) ,«- c (4 - (Ci A. Applicants prior experience in transportation of passengers: (4c B. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 1)-2-c>rreJ ��Ic��vn f^ttt� ntcF,�lsi lI S C. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? kt Type of Offense Where When D. Have you been convicted of any traffic offenses in the last five years? lJO Type of offense Where When E. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? MO Type of offense Where When F. DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY EACH ADDENDUM FOR POLICE CHIEF REVIEW FOR EVERYONE LISTED IN ITEM NUMBER 4. G. I understand that if I falsely answer any of the questions in this application, 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 � gt%(// rd, pP ) caner Must one of those liste of companya lication STATE OF IOWA COUNTY OF JOHNSON ) • - \ ` ' Subscribed and swom to before me by w ', t� C . 0 r kes, \� . On this c' day of-- - aQr '.t 20 t3 1 = an and for the No lic in and for the Stateafiowa 11V•t - - clerkftaxicompanyapp..doc 12/10 • t • IOWA • icusiAA DRIVER LICENSE - ORTEGA LLCRUZ•14 "•,,I 204 4TH STREET • . CONESVILLE,IA 52739 DLNO 775ZZ9301 - I iss 05/04/2013 EXP 04/29120 8 Classi) End.3 • lidt I . esti-lotions 07)77 al NONE . ,kaoNs B.tRO DOB 04129/19781 DR. 4 DO 769181838010933M290418R • .• • • • • . •• • • .' • . • • • • • .