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Home My WebLink About14-233 Authorization Number / `4 — 3 T • _ 1 (Office Use Only) VIII AN OP II lir APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday.) 410 East Washington Street Iowav Intva 52240-1826 Failure to complete the "required"information will result in denial of the application ( 19, 356-'so4 i 10/el (319) 356-5497 FAX Fid Middle Last 1. Name (REQUIRED) / ; 1116 �� GYHe Ccjo(o -z7. 2. Mailing Address (REQUIRED) ('D( Suwr.l't4-0,-IV'��S ( i CC: „t �- "+ S-;)- 3`4 3. Contact Information (REQUIRED) Email:(cid, c-(L1s„,r;ksdec 6-`(4 "C hone: -314 CI?? C(co 4. Prior experience in transportation of passengers: ��1l //' CSV C�12K..P�/ c�i cf/oGJ G.+ /3 <43e c>We / % f C�.i� S i 3 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 ben convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1'4) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ,, e�7 Type of offense Where cG When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 116 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 rlejne(s) IA 0 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CE 11FIEDI DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHFEVIE{N You must apply for an individual Department of Criminal Investigation Report(form availableuponirdquest) (OVER FOR REQUIRED SIGNATURE AND NOTARY) rs 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license"riumbe c7-l C_( v1—I c21— . 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 rovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)• 7. Signature of Applican' ��-.� Date /6 / 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. STATE OF IOWA ) COUNTY OF JOHNSON ) // //� Srib d nd sworn to before me by ��'�'Yt 0/ r �e' /'fL // . On this 4-4--- day of ,r°I�t,r KELLIE K.TUTTLE / e6--e 1° "; Commissi Nu ber 221819 Notary Public in and for the State of of Iowa lo;vs II 5- A*A A******************************************************************************************************************************************** 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). — _ L____ i-07/6(/(7 Signatur- • 'a - hief or designee 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. a'wce.-sz-/ , '4<�(�� / 7/7;•-1:"6// - Signature f Cit Clerk or designeeto Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update CIerI TAXIDRIVBADGEAPPL92014amended.DOC 09/2014 Iowa Department of Transportation n 011) Office.of Orr er Services (Toil Fre)600-53211121 PO Box 9204,Des.Mole , IA 50306-9204 515-'24419124 illIP PAX:515-2391183? Certified Abstract of Driving Record Inquiry Date: 10/10/2014 DL/ID#: 212CC2122 (IA) Customer#: 231444 Name: Coblentz,Timothy Class: D ID Status: None Dewayne Address: 101 SUMMERHAYS Audit#: 7173229 DL Status: VAL ST Issue Date: 07/26/2013 CDL Status: None City/State: TIFFIN, IA Expiration Date: 07/26/2018 CDL Cert Status: None 523409363 Endorsements: 3 CDL Med Status: None Mailing Address: 101 SUMMERHAYS Restrictions: NONE Restriction None ST Supplement: Date of Birth: 7/26/1971 Mailing TIFFIN, IA Sex: M City/State: 523409363 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/14/2013 03/21/2013 S92 Speed Johnson IA Name: Coblentz,Timothy Dewayne DL/ID: 212CC2122 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: • s i011CI1'h`% 10/10/2014 =_f , .` F 'IQW +4 —f ,s: D. O. T ►,Nk, Millin 7 Office of Driver Services - - .' - ' ?-� Iowa Department of Transporation : i Name: Coblentz,Timothy Dewayne DL/ID: 212CC2122 Oct, 15. 2014 11 : 31AM Div of Criminal Investigation No. 2050 P. 2/8 . UC• . 1U. LU14 IU:4LKm t,lty t,lerK - t,ity of Iowa Llty No. 7iV1 P. L • a�„01'P✓�,� • STATi E OF IOW ),,,-- ,A- i• ( . �.q,Iowak%, ecorrd Check ? ....,w--1/2�,,. . Criminal History .. • )` e".-3 /4 47„01 .. Request 'orcrtufl -:`t��,, „r �.V. _.. • . DCI Account Number; -F. (if-applicable) To: Iowa Division of Criminal Investigation Vromi City of Iowa City • Support Operations Bureau,1”Floor City Clerics office _ 215 E.7th Street 410 E,Washington Street bes lVLoincs,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)72S-6080 Fax • Phone; 319-356-5041 • Fax 319.3565497 I am.requesting an Iowa Criminal History Record Check on: _ • Last Name (mandatory) First Nanle(mandatory) Middle Name(recommended) ejfrtt2 ....„---r•, 1 t. �elici Date of Birth(mandatory) Gender(mandatary) Social security Number(recommended) a 746//9 7/ Wale Efremale ql ca 7 f 0 7(7 d . Waiver Information:Without a signed waiver Dom the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. _ • Waive?Release_i hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal • Investigation(DCO). Any criminal history data conccenlu tat.3s•cA•" ain • .y tib DCimay be released ay allowed by law. • Waiver Signature: 8 ' .• p/` • I--- •(: y.t j\A '7k - Iowa Criminal History Record Check Results (DC1 use only) As of t (At S 11 -k , a search of the provided name and date of birth revealed: • '•? • . • 4FPNo Iowa Criminal History Record found with DCI " 0 Iowa Criminal History Record attached,DCI it 3n 3 a$ ( I., DCI initials • ,tier -f roof'lcllm n I T' -7n 1 IA Alli / 4/1IAA1r U . I/lr Oct. 15. 2014 11 : 31AM Div of Criminal Investigation No, 2050 P. 3/8 IOWA CRIMINAL HISTORY DCI 00393287 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00393287 2014/10/15 NAME: COBLENTZ,TIM COBLENTZ,TIMOTHY DEWAYNE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19710726 M W 510 220 BLU BRO MED XA ADDITIONAL IDENTIFIERS CCH RECORD z** 01 ARRESTED 19890807 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708-1 0 ASSAULT CAUSING INJURY p a TRK#: 1,36556101 COURT DISPOSITION 1-4c, AGENCY: IA052015J JOHNSON CO DIST COURT ..E m COUNT NO- 01 IA STATUTE IA706-2-4 73 t7- ASSAULT O CHARGE CLASS: MISDEMEANOR CONVICTIONrrN TRK#: L36556101 SENTENCE AISP EFF DAT FINE $100 19891017 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE 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 AL