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Home My WebLink About14-026 Authorization Number -� �z 1 '(Office Use Only) sewl�� CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (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) 35650 (319) 356-5497 FAX First Middle Last _1__Name )ff __ ��Lt i� 2. Mailing Address ,p t�px �'� Cn✓L�,),tUL I Sa73q CTcmpo 3. Telephone: Home Other: (31n) L{F - 74:1 C 1 c Tn. oCckry ) 4. Prior experience in transportation of passengers: N aper- 5. Have you ever been convicted of any misdemeanors and;x felonies in this State or elsewhere? y Type of offense Where When ()k),;;- 1PNu7ccaL ri2,--7-7(,„ Tup^c 2003 Cono,LkCd D(c acs) 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? N o _ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /�U Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N 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) NC) 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) clerWtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Ir v I 5 1-2,r)CY1 e"-C\ . 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 .....20:01,v p . s of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) • Signature of Appli ..de�� Date STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by 5 On this day of TV= - •ublic in and for the State o wa -713jty ************#**********************#***#*************#*********************#*************##*************************#********##*#***#*********** 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). Signat of Poli ief 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. Signa re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 5 /" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerkttaxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation fl Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,W5030(1-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/31/2014 DL/ID 4: 839ZZ7105(IA) Customer 4: 3758715 Name: Roman, Luis Angel Class: C ID Status: EXP Address: 716 E 6TH ST Audit 4: 5763952 DL Status: VAL Issue Date: 01/27/2012 CDL Status: None City/State: WEST LIBERTY,IA 527761213 Expiration Date: 00/08/2014 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 716 E 6TH ST Restrictions: NONE Restriction None Date of Birth: 8/8/1985 Supplement: Mailing City/State: WEST LIBERTY,IA 527761213 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR 11/23/2003 03/26/2004 _ �A20 'O eratin While Intoxicated .._.._..__ _ ..._. W _ g ._,_,._._.._ _ _.._ Muscatine__ ..IA 09/20/2004 02/01/2005 _ _ `A20 ,Operating While Intoxicated Muscatine IA 06/26/2005 12/13/2005 :A20 Operating While Intoxicated Muscatine IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR ...-' _ .. �. .�._..v . . _ ._.._ ._ .J._ _..__......._._— _.._. .. ..'IA 11/23/2003 ......_ _ ._._ A98 OWI Test Failure . . .. .. ....... i _....... ...... _. . ........ ..._. _..... . .._ .... ... 09/20/2004 YA98 OWI Test Failure ]A 06/26/2005 :Al2 OWI Test Refusal IA Sanctions Type Effective End ACD Explanation Occurrence JUR 7UR .:. _. .. .. _ _. . _ _.... .._ ..y... . . ... .._....__.. _... _ _ Revoked 12/18/2003 06/15/2004 A98 OWI Test Failure SIA IA Revoked ,01/19/2005 01/19/2006 A98 'OWI Test Failure _ _ IA IA_ Revoked 07/07/2005 _ 07/06/2007 Al2 OWI Test Refusal IA IA Revoked 12/13/2005 12/11/2011 A20 Operating While Intoxicated IA IA Name: Roman,Luis Angel DL/ID:839ZZ7105 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: "piHlC/I At '.••.'.143A 1/31/2014 fig IOWA '�14 bi r,.—: . s. Offi of Driver s A1h�hD�ry[y-- IowaDepartment eof Transportation Name: Roman,Luis Angel DL/ID:839ZZ7105 Jan. 31. 2014 3: 28PM r Div of Criminal Invest igation Y ;No. 8304 1P. X1/4 • Nth 7.0) 1�1;,flJef STATE OF IOWA , Li,t 3.v (ift m (Crrp>mnfinnal]El<ilstoiry Record Cheek . 7 Request Form 11,0,;;c DCX AccountNumbert To1b'),-F- (Ifnppifcable) Tot Iowa Division of Crimluallnvestigation From: City of Iowa City • Support Operations Bureau,le"Floor City Cleric's Office 215B.70'Street4101 Z.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA 62240 (515)728.6080 Pax Phone; 319-356-5041 Font 319-356-5497 7-94:1-) '..,I ann requesting an Iowa Criminal Hist, Record Cheek on: Last Name (reandalory) First Name(mandatory) Middle Name(rcconwondcd) R0 vv, art L0 ''5 it Date of Birth(mandelory) Gender(mandatory) Social Security Number(recommended) `$ + B ( J`" ' cgMale Dremale L► i U - ) ? - ,3 g 1 Waiver Information:Without a signed waiver Prom thesubject of the request,a complete criminal history record may not be releasable,per Coda of Iowa,Chapter 692.2.Fpr complete criminal history record Information,as allowed by law,always obtain a waiver signature from rho aablect of the request, Waiver.Reiease:I hereby give pclallrelon for the eboyo1.gvo IIhgvfllelel.(vzoonduct saloon criminalldstory record chcckoriduhe Division of Criminal InvrsligMion(ACO. Any criminal history date concerning mo deale� •eta by iii. Inlay bereleasedas allowed by taw, Waiver Signatrl Sr--, �a-cao.n. Iowa Criminal Flistory.IRecojtl Check)Resul . `e .32cwta en40 U 2 �/ 7.c_ b As of 1-31- 1 ,a search of the provided name and date of birth revealed: ;�c. i to N 1..:M 1 n lD '7�.r II No Iowa Criminal History Record found with DCI ',vim a o S.� .L, y X �A N IOWR Criminal T-Tistoryl2ecord aIttaehedf_DCI# ~I 1 Zq•1� 'M DCIinitials \ ) , Received Time—Jan, 29, 2014 2:37PM"No. 1768 V nun-!7 roar /10C Jan. 31. 2014 3:28PM Div of Criminal Investigation No, 8304 P. 2/4 IOWA CRIMINAL HISTORY DCI 00712974 FELONY CONVICTION PAGE 1 OF 3 DATE PRINTED- 2014/01/31 DCI:00712974 NAME: ROMAN,LUIS ANGEL DOE SEX RAC HGT WGT EYE HAIR SRN POB 19850808 M W 508 209 BRO BLK LBR• IL • ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC R EYE SC R SHLD TAT BACK TAT L ARM • .TAT R SHLD CCH RECORD *** 01 ARRESTED 20031123 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE 1A3213-2 OWI 1ST OFP TRK#: M00253901 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 1ST OFF COURT CASE ID: 07701 OWCR028226 CHARGE CLASS: MISDEMEANOR CONVICTION TRU: MO0253901 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040113 PROBATION 18M 20040113 COMMUNITY SERVICE 40H 20040113 REVOKED 20040326 02 ARRESTED 20040225 AGENCY; IA0990000 POWESHIEK CO SO CHARGE NO- 01 IA STATUTE IA719-1 INTERF W/OFF ACTS TRIO: 068152001 CHARGE NO- 02 IA STATUTE IA123-47(2) P09S ALCOHOL U/AGE TRK#: 068152002 COURT DISPOSITION AGENCY; IA079015J POWESHIEK CO DIST COURT COUNT NO- 01 IA STATUTE IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS COURT CASE ID: 8791 SMSM12397 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 068152001 SENTENCE DISP EFF DAT • Jan. 31. 2014 3:28PM Div of Criminal Investigation No. 8304 P. 3/4 DCI 00712974 PAGE 2 OF 3 FINE $250 20040226 COURT DISPOSITION AGENCY: IA079015J POWESHIEK CO DIST COURT COUNT NO- 01 IA STATUTE IA123.47(2) -A POSSESSION OF ALCOHOL UNDER AGE - 1ST OFFENSE COURT CASE ID: 08791 SMSM012398 CHARGE CLASS: MISDEMEANOR CONVICTION TRKH: 068152002 SENTENCE DISP EFF DAT FINE 20040405 03 ARRESTED 20040820 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA321J.2 (2) (A) OPERATING WHILE INTOXICATED TRIO: M00391901 COURT DISPOSXTION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 XA STATUTE 1A321J.2(B) OPER VEH WH INT (OWI) / 2ND OFF COURT CASE ID; 07701 0WCR030303 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: MO0391901 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP ERF DAT TIME SERVED 70 20050201 SUSPENDED JAIL 60D 20050201 JAIL 67D 20050201 FINE $1500 20050201 PROBATION 1BM 20050201 04 ARRESTED 20050626 AGENCY: IA0700100 MUSCATINE PD CHARGE NO- 01 IA STATUTE 1A321J-2-2C OWI 3RD TRIO: 063153501 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE 1A321J.2 (C) OPER VEH WH INT (OWE) / 3RD OPWENSS COURT CASE ID; 07701 OWCR032038 CHARGE CLASS: FELONY CONVICTION TRK#: 063153501 SENTENCE DISP EFF DAT FINE $2500 20051213 Jan.-31. 2014 3:28PM Div of Criminal Investigation No, 8304 P. 4/4 DCI 00712974 PAGE 3 OF 3 PRISON 5Y 20051213 OWI PROGRAM 05 ARRESTED 20140128 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA708.2A(2) (A) DOMESTIC ABUSE ASSAULT TRIO: MA008F201 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 DCX. 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