HomeMy WebLinkAbout13-051CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-504
(319) 356-5497 FAX
First
1. Name <
Authorization Number /3 - S 1
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
h D Middle
a
Last u'
2. Mailing Address iL/VO tf-V C(FCt f (IJ t-,
3. Telephone: Home 3 9 - (o Z 9-- C� 9 ? 3 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
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? No
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
v Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? [ y
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 SRI FIED
ggD(ING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIM
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)
de Ma,dnvbadg 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nuint
/ 3 k�k 6 �-Ir/ . 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 Applicant— Date y- 20 e�?
STATE OF IOWA )
COUNTY OF JOHNSON )
�trIr,,b_e_dr/� and s orn Jai before me by ? �[�Ti C) Z— On this I ' ` day of
`ter C.t�1 Ol i
�far KELLIE K.TUTTLE
s a� Y Commission Number 221819 Notary Public in and for the State of Iowa
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).
L6j-4,
ofpoll6phief or designee
AolY ''/ ZO/3
Date
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, _ea4,t_1 3 - �/- /3
Signature of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
de widwbadgeaW201O,dm 09/2012
t
Iowa Department of Transportation
Office of Driver Sefvices (roll Free) Wil -532-1121
PO Box 9204, Des Manes, IA 50305-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/28/2013
DL/ID #:
713YY6581(IA)
Customer #:
925165
Name:
Ruiz, Rufino
Class:
A
ID Status:
None
Address:
208 KNOTTY CIRCLE DR
Audit #:
6533485
DL Status:
VAL
_...._..... ....
01/16/2012.
-
102/13/20I2
Issue Date:
12/11/2012
CDL Status:
VAL
City/State:
WEST LIBERTY, IA
Expiration Date:
08/22/2013
CDL Cert Status:
None
08/15/2012
527761042
864
No Insurance Card
.52
IA
Endorsements:
N
CDL Med Status:
None
Mailing Address:
208 KNOTTY CIRCLE DR
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
8/22/1955
Supplement:
Mailing City/State: WEST LIBERTY, IA
Sex:
M
527761042
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
3UR
/10/2008
06/30/2008
M81
_Careless Driving
r
_iNI
01/16/2012_
-X
0?/13/2012_
N50
.... F
Improper.Turn52
.. ... i_
1. -
{IA
._..
_...._..... ....
01/16/2012.
-
102/13/20I2
N04
Fall to Yield to Emergency Vehicle
52
IA
08/15/2012
:08/27/2012
iImproperUse of Registration
08/15/2012
:08/27/2012
864
No Insurance Card
.52
IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number 3UR
07/16/2003 13045918 UA
Name: Ruiz, Ruflno DL/ID: 713YY6581
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, ave cause my s gna ure ana Ine s document.—at-Ankeny,—lowathis-date:--
••:�!'%V�
2/28/2013
tr°'c,
IOWA0.
C416 06'10�4
s>
i•'DA. S'
Office of Driver Services
r�BRIM
Iowa Department of Transportation
Mar. 1. 2013 8:52AM Div of Criminal Investigation No.4981 P. 10/11
'. Fe6,25, 2013 12:34PM City Clerk — City of Iowa City No,3266 P. 2
.CSIN,l!r/Orer
r: �sfii
`!'o: Yo{ya571v7s1o110fCXiYm7taZ.thVesCfggtPort
" '•,SupportOperationsNuragv,la1k+Yaor
215E,1t� Sfreai •
DBsP/1pPrres,SoWd 50319
(979 7Z5 6046
(578) 71fi bOBO Irsx
a T.�
f:c--•� ifitli-
,r.• •t u
DCSAacountNumbor; �bDa"'� -
' Qtappr7tab cj
Fra1nr ciuOV Tom cTT-T
CZT%' Ov °9 OMOX
Mo li WAS'01T STl`MT
TOWA GYTB IC19A 52W
Auld, �i19.9�6�50ki
Cheok on-
�`� Llvamaye I ,�( �' � " � � 0 2 l
WaivtaPXYafoy,wdrIon, Without as!$nedwatyarfrom iftosublutofthaxegaaa4, a @oMplofAol AfRA1hbfary raoordluoynoc
Bareldagnble,BdrCode odditp Chapter69332.37orccomp tabrinttnaThfstoryrecorrYlnfoxmAtlmr,asalYawdd�ylAyr,always
-abtatilrawatvarsf natayehomfTta&u6 oa¢aT�Pha�E liost;'—'- - '— - -
�6!'YCi'.i8i6((y'g7lhefCDygIYBParMfeJ(drt LEr�ltba6oYdrEg4E91ing OffPwel (o SartdBc1$Ir%Wa odmfanl6ls(oty[ocafddfleaNV/IA IfleDl1d510R0PCninlnol
YaWcAlgat%g (POO. pnyerlhikPIMaMryA dOif runtgal'i(JA �%ntalne4fyy>h°DOYmgy6utolcosedWnl(oWeQ byinw.
a seorch. bf the)lrovid't:d llama Ofid data ofTlliih revealed:
�,�J >`�o ibwa f!t•J�iitei7�istorykecoxd x"Dano withDC1'
Q Toga G4llnfnaTS�'tsloxy�2eoord atiaohed, ]�C1_'lk
bCZ 3DiHals
'•:.;.' is