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Home My WebLink About14-163 Authorization Number L£�L93 l - 1 (Office Use Only) 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 45r,s,t II dle Last 1. Name �A 1 W4 l (45, �q (`ra' Ps�0S. 2. Mailing Address 329 F t 1 1 5 AQcG J 3. Telephone: Home (� Other: C(c- 72 U_g? I-7 I 4. Prior a perience in transportation of passengers: Dv OAR Sc 1od\ s f i k.`s C(ou o rr er-) -carr T -- evic 4—I-� STI C. 6cr 'r-PK-.'r 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? !Uc) Type of offense Where When 6. Have you e n 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 7. Have you been convicted of any traffic offenses in the last five years? qe T e of offense AiNhere When Ski)g alo fi,.A 1 C (cog 2�2 Peak , (6-00P j---.A, �t ( Z°NA 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? E) Type of offense Where When SOSe( cc s 1U<r Pt4ez.c p ,T1:4- 01 1 z (70(5 9. Have ypu,ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) C.) 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) clerk/taxidrivbadg 03/2014 A I hereby e h t, I, h ssued to me by the Iowa Department of Transportation a valid Chauffeur's license number /0 L t L (Q . 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 y and all records and documents relating to this application, and I further agree that, if a license is granted, to comply at . t... -.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 (j►`` Date 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 ) Ascnbed and sworn to before me by � d'1 i C Aa r'rec --Dre---C . On this 1 S " day of 1__ P_Li- , K le.tfte , � l ,rc KELLIE K.TUTTLE NotaryPublic in and for the State of Iowa Commissio Num x(221819 i i My!/7flPI1S F�ce . *********************************************** **************************************************************************************** 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). � � 01-1?—/ / Signet e of Pol r er 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. Signature of City Clerk or designee Date 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 clerkhaxidrivbadgeapp2014.doc 03/2014 4: . ,- ---i(iti4 L-4 . SMARTER I SIMPLER I CUSTOMER DRIVEN 3QVtl CfOt.�OV Office of Driver Services PO Box 9204 I Des Moines,IA 50305-9264 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 vaiowadoLgov Certified Abstract of Driving Record Inquiry Date: 7/23/2014 DL/ID #: 102884476 (IA) Customer#: 4521879 Name: Ybarra-Rojas, Anibal Class: B ID Status: None Alphonse Address: 919 S 16TH ST APT 417 Audit#: 6865594 DL Status: VAL Issue Date: 04/16/2013 CDL Status: VAL City/State: AMES, IA 500108161 Expiration Date: 07/04/2017 CDL Cert Status: Excepted Intrastate Endorsements: PS CDL Med Status: None Mailing Address: 919 S 16TH ST APT 417 Restrictions: Commercial Instruction Restriction CDL Instruction Permit Permit, Corrective Lenses Supplement: Expires 8/14/2013 Date of Birth: 7/4/1988 Mailing City/State: AMES, IA 500108161 Sex: Ni History Information Convictions Citation Date Conviction Date ACID Explanation County JUR 09/07/2012 10/08/2012 . 592 ;Speed (10 mph&under in 35-55 mph zone) ,Boone IA 05/30/2014 07/08/2014 ,S92 'Speed Boone IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 11/01/2013 765880 !IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended - .01/15/2013 01/30/2013 D53 Non-Payment of Iowa Fine 'IA IA Name:Ybarra-Rojas,Anibal Alphonse DL/ID: 1028B4476 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I a 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 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: l o%OEHICIf p1G�y' ,,,i .: IOWA:*g4,/ 7/23/2014 %_'.D. O. T w' -. os%o``t,og. l2. _2014 11 :21AM Div of Criminal Investigation a DCI 1ar,No. 7097 P. I/I . °( tel • . . • STATE OF IOWA ,.: Criminal History Record Check . lr •. w Request Form Jl„ • - . DCI Account Number. . 1383-Ft- tihpptic ao) To; JIM DlvhlnnofCriminal investigation 'Frumt MA CEO TiXl Support Operatlona Bureau,l^Floor S tw<Ms a Y 216 P..7°Slreel • Des Who,lima 50319 p • r'- ,A--5:a44.0__________ (513j7E5:6066 (915)7254080 FRY Phone; t(3l9 33P. r; it Fax:. . (311) 551-$J-'11 I am requesting an Iowa Criminal History Remind Check Co: Middle Name(Reemnxnaca) Last Nome inundatory) First Name(adecco Date el Birth(,o.au,� �C Gen(der�(mmdwoco Social Security Nuimber(moon ) • -_()?-6(Y-1 //9 ° �+lwe °Female' `RI et7-L,( m • •••- Waiver b(flMmllart:Without a signed waiver from the subject of the regatta,ata mpmmalete criminal tion,al allowed rebycord lawmay not . be releasable,per code otlov a,Chapter 6921.For poinolete Sinful history alway obtain a waiver slahktiire from the gabled of the rawest Waiver Release:t herebydve pmmintos for to tognemNe cetctl bestdua F tom mmmd away WS cheek with dr olvhton ofCrhui,uc Invmdtnlon(DC7).Any criminal htaayd,n W. 4omkts4e0 be do bei may be t&mai udined by ijw. Iowa Criminal History Record Check Results ' (WC1use only) As of C5"\)- lL . ,a search of the provided name and date of birth revealed: .... No Iowa Criminal History Record found with DC[ . . ❑ Iowa Criminal History Record attached,DCI ii '; ' DCI initialsC3FI•�, DCI-77(06/25/10) ' Received Time hug, 5, 2014 5:21PN No. 6580