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Home My WebLink About14-165 Authorization Number /41-/15,5- . 1 i (Office Use Only) N,fia...7.®drat . "nl ft. Aim aciir APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE 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 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1First Middle - Last 1. Name --1.1 .r Cr bin ?.."011 r 49 'SCYCArV) d 2. Mailin 'Address ,3 C° /CC e' / /(/ kJ _Sr 3. Telephone: Home 3/ - Y 99 Ce 0 Other: 4. Prior experience in transportation of passengers: /4//A 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? `10 Type of offense Where When 6. Have you peen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? C Type of Offense Where When 'OW r Okcyt,s),4 C' C7 tit 1/' AP r, ( Qo l l 7. Have you been convicted of any traffic offenses in the last five years? ye 3 Type of offense Where Whent Jr‘ i - v--t th' ., .. (6 i x c-i _ -c c k� /, -pc) / / 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? nc3 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) YD 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) derkltaxidrivbadg 03/2014 I h9reby certify that I have issued to me by the •wa Department of Transportation a valid Chauffeur's license riumber . I understand that if I falsely answer any questions in this application, that this application may be denied,' :ilea`s anillnaf if I falsely answer any of the questions in this application, that this application will be denied—f-agre at—tfiat 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) q - ?7 - Signature of Applicantif F 'Z Date lu 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 /4-, [a iLk f- . S Qc{-ci LA.c-\ . On this day of A .. . .7019- . ► I _ . V s., t..&. o.'R;q(�� WENDY S.MAYER Notary 'ublic in -no for the State of dIra cel,„„.—„,,rvurnoer' 428; • F' • 4y Com issi n Expires 1 1pW ****************************** "************************************************************************************************************ 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). 1 N7/ / i:/;/ 1\- SignaturepfPolice 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. • -C-1---,-0-77....) A) - '--k-1,azt,t) ?//e / Signatur of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2014.doe 03/2014 Aug. 13. 2014 4: 13PM Div of Criminal Investigation hNo. 6984 1 Ll/4 • Il V F: • V. L V I T 7.7viii V l l r v 1,.111 V l l.) Vi I V If LL V I i f • Z. �,,>,; av STATE OF IOWA . " .40:4 ', ?, . �•o `� Criminal History Record Check . • :. . ;' `?'.l� • . �`..cauls • Request -'e • �grCn(rp lt''� 1 /4,7_1.* a; DCIAccountNutnber;_ L/ao-r re...nom) To: Iowa Division of Criminal Investigation From; City of Iowa City . Support Operations Bureau,rt Moor City Cleric's Office . • . 2,15 E.7111Street 410 E.Washington Street Des Moines,Iowa 503I9 (515)725-6066 Iowa City, 14 52240 (515)12S-6080 Fax . Phone: 319-356-5041 . - x'ass 319356-5497 • I am requesting an.Iowa Criminal History Record Check on: Last Name (mandatory) First Name(mandatory) Middle Name(recommended) 4\ (Ann An 4 vis t) Date of Birth(mandatory) 'a' Soia Gender(mandatory) Social( Security Number(recommended) I - 13 - ale ❑Female l 0 a " 1 5- - 3 a7 / • . waive},Information:Without a signed waiver from 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. Waiver Release:i hereby give permission for the abovetegnesting official to conduct en lorva criminal history reseed check with the Dlvislon of Criminal • invcsligellotl(DCh). Any etinlinal history dais coacenil gine that is maintained by the DC[ be released as allowed bylaw. •' Waiver Signature: / ______--~ • Ce Criminal History Record Check Results (DCluseonly) , As of t� 1 2J'1 LI • ,a search of theprovidedname and date of birth revealed: . • - 8 No Iowa Criminal History Record found with DCI 1)4 Iowa Criminal History Record attached;DCr# 1�?7 n� DCI initials CD ;' tv DCI-77(08/25/101 Received Time Aug. 8. 2014 4:39PM h. 6713 Aug. 13. 2014 4: 13PM Div of Criminal Investigation No. 6984 P. 2/4 IOWA CRIMINAL HISTORY DCI 00879293 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED- 2014/08/13 DCI:00879293 NAME; SERRANO,HIRAM ANTONIO JR DOE SEX RAC HGT NOT EYE HAIR SKN POB 19881013 M W 508 330 BRO BLIC LBR IA ' ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT BACK TAT CHEST TAT L ARM TAT R ARM TAT UL ARM TAT UR ARM CCH RECORD *** 01 ARRESTED 20091008 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA124.401(1) (c) CONTROLLED SUBSTANCE VIOL. TRK#: MA003V301 CHARGE NO- 02 IA STATUTE IA124.401(1) (a) CONTROLLED SUBSTANCE VIOL. TRK#: MA003V302 COURT DISPOSITION AGENCY: IA070015.1 MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE XA124.401(1) (C) CONTROLLED SUBSTANCE VIOL. COURT CASE ID; 07701 FECR041918 CHARGE CLASS: NON CONVICTION TRK#: MA003V301 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20100205 PROBATION 25Y 20100205 RESIDENTIAL FACILITY 9990 20111028 DISCHARGED FROM 20120309 DEFERRED JUDGEMENT COURT DISPOSITION AGENCY: IA070015.1 MUSCATINE CO. DIST COURT COUNT NO- 02 IA STATUTE IA124.401(5) POSSESSION OP A CONTROLLED SUBSTANCE COURT CASE ID: 07701 PECR041918 CHARGE CLASS: NON CONVICTION TRK#: MA003V302 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20100205 PROBATION 18M 20100205 RESIDENTIAL FACILITY 9990 20111028 DISCHARGED FROM 20120309 DEFERRED JUDGEMENT Aug. 13. 2014 4: 13PM Div of Criminal Investigation No. 6984 P. 3/4 DCI 00079293 PAGE 2 OF 3 02 ARRESTED 20110205 AGENCY: IA0110100 STORM LAKE PD CHARGE NO- 01 IA STATUTE IA123.46(2) -A CONSUMPTION OF ALCOHOL TN A PUBLIC PLACE TRK#: LA0039V01 COURT DISPOSITION AGENCY: IA011015J BUENA VISTA CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46(2)-A CONSUMPTION OF ALCOHOL TN A PUBLIC PLACE • COURT CASE ID: 03111 SMSM042965 CHARGE CLASS: MISDEMEANOR CONVICTION TRIC#: LA0039V01 SENTENCE DISP EFF DAT FINE $100 20110222 03 ARRESTED 20110619 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE 1A321J,2(A) OPER VEH WH INT (OWI) / 1ST OFF TRIO: 1A0002F01 CHARGE NO- 02 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 TRK#: 1A00C2F02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 AGCR094660 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A00C2F01 SENTENCE DISP EFF DAT JAIL 2D 20110619 FINE $625 20111005 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA321J,2(A) OPER VEH WH INT (OWI) / 1ST OFF COURT CASE ID: 06521 AGCR094660 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A00C2F02 SENTENCE DISP EFF DAT JAIL 2P 20111005 PINE $1250 20111005 • 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 Aug. 13. 2014 4: 13PM Div of Criminal Investigation No. 6984 P. 4/4 • COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION Page 1 of 2 4 ...........„ DOT www.i0wadot.g0v SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 • Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837- www.iawadoLgav Certified Abstract of Driving Record Inquiry Date: 7/30/2014 DL/ID#: 435ZZ0409 (IA) Customer#: 4710775 Name: Serrano, Hiram Antonio Class: C ID Status: VAL Address: 915 HOFFMAN ST Audit#: 7876325 DL Status: VAL Issue Date: 03/13/2014 CDL Status: None City/State: MUSCATINE,IA Expiration 10/13/2018 CDL Cert None 527614513 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 4913 OAK CREST HILL Restrictions: Motorcycle Instruction Restriction None RD SE Permit Supplement: Date of Birth: 10/13/1988 Mailing City/State: IOWA CITY, IA Sex: M 522408981 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 02/11/2007 05/01/2007 M42 Improper Lane (changing lanes) Johnson IA 02/11/2007 05/01/2007 B51 No Driver's License Johnson IA 06/25/2007 02/08/2008 B20 Driving While Suspended, Denied, Cancelled, Revoked Muscatine IA 12/21/2007 02/08/2008 B20 Driving While Suspended, Denied, Cancelled, Revoked Muscatine IA 05/14/2008 06/19/2008 B51 No Driver's License Johnson IA 09/06/2009 11/20/2009 B20 Driving While Suspended, Denied,Cancelled, Revoked Muscatine IA . 09/06/2009 01/08/2010 B20 Driving While Suspended, Denied,Cancelled, Revoked Muscatine IA 12/22/2010 02/11/2011 S92 Speed Johnson IA 12/22/2010 02/11/2011 B20 Driving While Suspended, Denied,Cancelled, Revoked Johnson IA 06/19/2011 10/05/2011 A20 Operating While Intoxicated Johnson IA 06/19/2011 10/05/2011 B21 Driving While Barred Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence .ACD Explanation JUR 06/19/2011 A98 OWI Test Failure IA Sanctions Type' Effective End ACD Explanation Occurrence JUR JUR Suspended 06/21/2007 08/25/2007 D27 Violation of Probation IA IA Suspended 06/22/2007 08/26/2007 D27 Violation of Probation IA IA Suspended 09/24/2007 11/24/2009 D53 Nor-Payment of Iowa Fine IA IA • Suspended 10/01/2007 11/24/2009 D53 Non-Payment of Iowa Fine IA IA • 7/30/2014