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Home My WebLink About14-203 Authorization Number /5 -&o 3 1 (Office Use Only) ftt 11141r 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 Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) 512s-,->I rs)►1t5� itie n..o_...ctr2 2. Mailing Address (REQUIRED) (3 r n" /4- e 3. Contact Information (REQUIRED) Email: AA �. - a • _ ell Phone: (3 in$`1 (3G 13- 4. s4. Prior experience in transportation of passengers: 1,17,k,,, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? kt)FJ� Type of offense Where When 041 erS4 07, 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? At) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? (Qi Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ",J Type of offense Where When 41:'- r.j ; )-C 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro the-i me(s'jr.- .. n • r.) 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) 09/2014 ii. . • I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number (06a_t?Y 4-1-13 . 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 recore and documents relating to this application, and I further agree that, if a license is granted, to comply at all time ith all . t • provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) ///(1//i/,, / Signature of Applicant - ._All" • Date / 1(// /i/ 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 ) Subscribed and sworn to before me by 1,.01,t1e4J--th 0 . 1'-}p rVoL„�cQe-r . On this /e-, -L2,11/4day of be Mal WENDY S MAYER NoPublic in and f.i a State4 of Iowa r ry r Commission Number 7294281 ta ' MY,Commisslon Expires low J't - i 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). ZJ " f ball'i Signature of Police Chief 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. )7L ,.,_,,..„,„....../, e . --K4-•....., iS, Si natur�of CityClerk or designee Date 9 9 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 Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 09/2014 „00001114 lowA DoT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 i 800-532-1121 I Fax:515-239-1837 www.iowadoigov Certified Abstract of Driving Record Inquiry Date: 9/9/2014 DL/ID#: 662YY4723 (IA) Customer#: 4151224 Name: Hernandez, Roberto Class: D ID Status: EXP Ortega Address: 65 20TH AVE SW Audit#: 7203716 DL Status: VAL Issue Date: 08/03/2013 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration 09/22/2017 CDL Cert None 524045913 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 135 33RD AVE SW APT Restrictions: Corrective Lenses Restriction None 3 Date of Birth: 9/22/1984 Supplement: Mailing City/State: CEDAR RAPIDS, IA Sex: M 524045913 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/22/2010 11/02/2010 515 Speed IL ry c Name: Hernandez, Roberto Ortega DL/ID: 662YY4723 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Departrd it4rOf Tfansport=, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is .ie•and curate copy of an official record currently in the custody of said office,and that I have been authorized by the Director-etLiltIowa Departrrrpnt of Transportation to so certify. ! 17 -0 . C e = s: N) 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: - 4=— r'.r: �EVilCIE 4 • .........`/�+h7 9/9/2014 P.' IOWA 'sr9 f*its: :*o 44;47.0 calie„,„„exii.4 D. O. T. it., • 4.4 URlVE.%. IowaiDepartmentPortationeof Driver ervicesns ..� Name: Hernandez, Roberto Ortega DL/ID: 662YY4723 Aug. 26. 2014 9 : 41AM Div of Criminal Investigation No. 7997 P. 2/2 nug, LV, LVI4 L ; vvrIyi t,tty t,terK — 1,1ty uI toWd titty • ,No. 7997 F. L • • ,�YOrriii, STATE 01F 7I0WA ;,'r„„ Of 3 �� • Criminal History Record Check 1. x•'4•`• ''' inmA)� .i -,,v,• •Y 't `, �1�/ Request Forma . • ..,,;. .�5.,,. DCI Account Number; 41 d d (itappl cable) To: Iowa Division of Criminal Investigation From: City of Xowa City Support Operations Bureau,1"Floor City Clerk's Office 215 E.714 Street 410 B.Washington,Scree Dos Moines,Iowa 50319 (515)725-6066 Xowa City, TA St ,, . cn (519)72S-6080 Fax -=1 '-o Rhone; 319-356.5041 c,-C -- r- - Fax: 319-356-5297 =lc, "'_a___— rn- -: N) I ain re,uostin. an Iowa Criminal History Record Check on: -Last Name(mandatory) First Name (mandatory) , Middle Name(reoomnteichlo Date of Birth (mandator)) Gender(mandatory) Social Security Number(reoommandcd) 07/21.,//kri XMale °Female jAVZ- .41 Waiver Information: Without a signed waiver from the sublett 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 81:nature from the sub ect of the re•nest. . • Waiver Release:1 hereby give permission&orthe obey- •i ues ing ofiici:%o'induct.. Iowa criminal history record cheek with the Division of Criminal I'nvetlgelfon(DCI). Any criminal history data conoemin: • -tI aim, . , ic 0 may be released as allowed by law. Waiver Signature: ‘idibi/ , " ' 9... 41 ' 1 Lova Criminal izstorry Record Check Results ,pc',w:Gani,•) As of %.... .U.'11-1 , a search of the provided name and date of birth revealed; ; k No Iowa Criminal History Record found with DCI - -" . 0 Iowa Criminal History Record attached,DCI# r lDCl initials _ cl-P Received Time7'Aug, 20, 1(2014 1 : 59PM No. 7527